血小板计数/脾脏长径比值预测食管胃静脉曲张的临床研究

Clinical evaluation of the platelet count/spleen diameter ratio on predicting esophageal and gastric varices

目的本研究回顾性分析血小板计数与脾脏长径及二者的比值对食管胃静脉曲张及其严重程度的预测作用。方法收集2003年及2004年收住我院的肝硬化患者及非肝硬化共76例,肝硬化56例,其中13例经上消化道钡餐检查诊断为食管胃静脉曲张,43例入院时同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及其它能影响血小板数量和脾脏大小的疾病,重度食管静脉曲张者20例(46.5%),轻中度曲张者12例(27.9%),无静脉曲张者11例(25.6%),非肝硬化共20例为对照。记录外周血小板计数、B超下脾脏最长径及门静脉宽度、胆红素、白蛋白等各项指标,并按ChildPugh分级法对患者进行评分,相关数据进行统计分析。结果43例经胃镜检查的肝硬化中,脾脏长径及血小板数/脾长径比值与有无食管静脉曲张及其严重程度有显著相关性(P分别为0.016和0.039),100%的重度食管静脉曲张患者比值<909;血小板计数与有无食管静脉曲张及其严重程度无显著相关性(P=0.076);血小板计数、脾脏长径及二者的比值与有无胃静脉曲张均无显著相关性(P分别为0.389、0.523和0.677)。56例肝硬化中,ChildPugh分级与血小板计数值、脾脏长径及血小板数/脾脏长径比值之间在统计学上无显著相关性(P分别为0.139、0.105和0.104)。结论血小板计数/脾脏?

Objective The aim of this study is to retrospectively evaluate the role of the platel et count/spleen diameter ratio in detecting the presence of esophageal and gastr ic varices and their severity. Methods Fifty six cirrhotic patients and 20 non-cirrho ti c patients were enrolled. Patients who had previously undergone sclerosis and b a nd ligation of esophageal varices and had other diseases that could influence th e platelet count and spleen size were excluded. Forty three cirrhotic patients underwent endoscopy and abdominal ultrasonographic examination at the same time. Twenty(4 6.5%) patients had sever esophageal varices, 12(27.9%) patients had mild-moderate e so phageal varices and 11(25.6%) patients had no varices. Platelet count, spleen di ameter, count/spleen diameter ratio, liver biochemistry such as bilirubin and al bumin, and Child-Pugh score, etc, were recorded and compared statistically. Results In 43 cirrhotic patients who underwent upper endoscopy and ultrasonogra phic examination, the spleen diameter and platelet count/spleen diameter ratio w ere significantly associated with the presence and severity of esophageal varice s(P=0.016,0.039 respectively). Patients who has a platelet count/splee n diam eter ratio of less than 909 can be excluded from having sever esophageal varice s, but the ratio were not associated with the presence of gastric varices(P =0.3 89,0.523,0.677 respectively). The Child-Pugh score were not associated wi th p latelet count , spleen diameter and platelet count/spleen diameter ratio (P=0.139, 0.105 and 0.104 respectively)in all 56 cirrhotic patients. Conclusion The platelet count/spleen diameter ratio, as an non-invasive tool, could be used to predict the presence of sever esophageal varices.