肝硬化食管静脉曲张无创性预测指标的探讨

A noninvasive index for the prediction of esophageal varices in patients with liver cirrhosis

目的回顾性分析外周血血小板计数与脾脏长径比值对不同病因肝硬化合并食管静脉曲张的预测作用。方法收集我院肝硬化住院病例共107例，其中乙肝肝硬化59例，酒精性肝硬化32例，原发性胆汁性肝硬化16例；有食管静脉曲张73例，无食管静脉曲张者34例。记录外周血血小板计数、B超下脾脏最长径值、血清白蛋白、转氨酶及凝血酶原时间等各项指标。应用Ginanni等研究发现的909作为血小板计数与脾脏长径比值阈值进行评估分析。结果有食管静脉曲张的患者与无食管静脉曲张患者的凝血酶原时间[（13．0±1．5）s比（15．7±3．1）s]、脾脏长径值[（128±23）mm比（148±41）mm]、白蛋白[（36．0±5．4）g／L比（31．0±2．6）g／L]、血小板计数[（9±6）×10^9／L比（5±3）×10^9／L]、血小板计数和脾脏长径比值[（760±529）比（438±317）]相比差异均有统计学意义。909作为血小板计数与脾脏长径比值阈值适合于国人，其预测食管静脉曲张存在的敏感性达到91．8％，特异性为71．3％。结论血小板计数／脾脏长径比值可以作为非侵入性方法进行食管静脉曲张存在的评估，且909可以作为阈值对我国肝硬化人群是否合并食管静脉曲张进行预测。

Objective To retrospectively evaluate therole of the platelet count/spleen diameter ratio in detecting the presence of esophageal varices in patient with cirrhosis of various etiology. Methods In this study, 107 cirrhotic patients were enrolled. Patients with a history of previous endoscopic or surgical therapy were excluded. The presence of esophageal varices was identified by endoscopy or barium upper gastrointestinal radiography. All patients underwent abdominal ulrasonographic examination, platelet count, spleen diameter, platelet count/spleen diameter ratio, liver function index such as albumin, prothrombin and Child-Pugh score were recorded and compared. Platelet count/spleen diameter ratio with the cutoff value 909 was analyzed and evaluated. Results Albumin, prothrombin, platelet count, spleen diameter and the platelet count/spleen diameter ratio were significantly associated with the presence of esophageal varices （P 〈0. 01 ）. The Ginanni＇s cutoff value 909 was of diagnostic efficiency, the sensitivity was 91.8% , specificity was 71. 3%. Conclusion The platelet count/spleen diameter ratio, as a noneinvasive index, could be used to predict the presence of esophageal varices.