肝硬化重度食管静脉曲张的临床预测

Prediction of sever esophageal varices in patients with cirrhosis

目的 回顾性研究重度食管静脉曲张的临床预测方法。方法 收集 2 0 0 3年收住我院的肝硬化 3 1例 ,重度食管静脉曲张者 2 0例 (64 .5 %) ,无静脉曲张者 11例 (3 5 .5 %) ,入院时行胃镜直视和腹部超声检查 ,并除外已行内镜下曲张静脉硬化剂或皮圈结扎治疗者。记录外周血小板计数、B超下脾脏长径及门静脉宽度、胆红素、白蛋白和凝血酶原时间等各项检查结果 ,并按Child Pugh分级法对患者进行评分 ,相关数据进行统计分析。结果 外周血血小板数值和脾脏长径与食管重度静脉曲张之间有显著相关性 (P分别为 0 .0 42和 0 .0 2 4) ,血清总胆红素值、白蛋白、凝血酶原时间、Child Pugh值及超声下门脉宽度与食管静脉曲张程度之间则无显著相关性 (P值分别为 0 .14 1、0 .95 2、0 .0 95、0 .0 88和 0 .12 4) ;与无静脉曲张患者相比较 ,血小板计数 <60 0 0 0个 /mm3 判断食管重度静脉曲张的敏感性和特异性分别为 60 %和为 80 %,脾脏长径 >15 0mm判断重度静脉曲张的敏感性和特异性分别为 65 %和 92 .9%。结论 血小板计数和脾脏长径作为非侵入性方法可用于预测肝硬化患者有无重度食管静脉曲张。

Objective The aim of this study was to determine whether clinical variables could be used to predict the presence of sever esophageal varices. Methods Thirty-one cirrhotic patients were enrolled. All of patients underwent endoscopy and abdominal ultrasonographic examination at the same time.Patients who had previously undergone sclerosis and band ligation of esophageal varices were excluded. Twenty (64.5%) patients had sever esophageal varices and 11 (35.5%) patients had no varices. Platelet count, spleen diameter, portal vein diameter, serum bilirubin, albumin and prothrombin time were recorded and Child-Pugh score were calculated. We analyzed the association between these variables and sever esophageal varices.Results The spleen diameter and platelet count were significantly associated with the presence of sever esophageal varices (P =0.042, 0.024,respectively). There were no association between serum bilirubin, albumin, prothrombin time, Child-Pugh score and portal vein diameter and sever esophageal varices (P=0.141, 0.952, 0.095, 0.088 and 0.124 respectively) . Compared with patients without esophageal varices, a platelet count <60000/mm3 could be used to predict sever esophageal varices with sensitivity and specificity of 60% and 80% respectively,and the sensitivity and specificity of spleen diameter of >150mm to predict sever esophageal varices were 65% and 92.9 respectively.Conclusion The platelet count and spleen diameter as an non-invasive tool could be used to predict the presence of sever esophageal varices.