肝炎肝硬化患者并发食管胃底静脉曲张破裂出血的预测指标研究

Predictive Indicators of Esophageal Varices Bleeding in Hepatitis Patients With Liver Cirrhosis

目的了解血清腹腔积液清蛋白梯度(SAAG)、门静脉内径(PVD)及血小板计数与脾长径比值(Plt/S-D)联合应用对肝炎肝硬化患者并发食管胃底静脉曲张破裂出血的预测价值。方法抽取2013年1—12月,在潍坊医学院附属潍坊市人民医院接受住院治疗的肝炎肝硬化患者50例。根据有无食管胃底静脉曲张破裂出血,将其分为出血组(n=26)和非出血组(n=24)。比较并分析两组SAAG、PVD及Plt/S-D,绘制SAAG、PVD、Plt/S-D及三者联合应用对肝炎肝硬化患者并发食管胃底静脉曲张破裂出血预测的受试者工作特征(ROC)曲线。结果 (1)两组SAAG、PVD及Plt/S-D比较,差异有统计学意义(P<0.01);非条件Logistic回归分析显示,SAAG、PVD及Plt/S-D对肝炎肝硬化患者并发食管胃底静脉曲张破裂出血的影响有统计学意义(P<0.05)。(2)SAAG、PVD、Plt/S-D对肝炎肝硬化患者并发食管胃底静脉曲张破裂出血预测的ROC曲线下面积分别为0.74、0.81及0.67。SAAG取值为20.50 g/L时,灵敏度为80.8%,特异度为58.3%;取值为20.10 g/L时,灵敏度为65.4%,特异度为62.5%。PVD取值为13.50 mm时,灵敏度为80.8%,特异度为66.3%;取值为14.25 mm时,灵敏度为65.4%,特异度为83.3%。Plt/S-D取值为0.88×109个/mm时,灵敏度为80.8%,特异度为66.7%;取值为0.97×109个/mm时,灵敏度为65.4%,特异度为66.7%。(3)SAAG、PVD及Plt/S-D联合应用对肝炎肝硬化患者并发食管胃底静脉曲张破裂出血预测的评分公式为:预测出血评分=SAAG×PVD÷Plt/S-D,ROC曲线下面积为0.91,取值为890.35时有最佳的灵敏度和特异度,分别为87.8%和90.7%。结论 SAAG、PVD及Plt/S-D是肝炎肝硬化患者并发食管胃底静脉曲张破裂出血的影响因素,三项联合应用对肝炎肝硬化患者并发食管胃底静脉曲张破裂出血的预测价值较高。

Objective To evaluate the value of the combined application of serum -ascites albumin gradient （SAAG）, portal vein diameter （PVD） and the ratio of platelet count/spleen-diameter （Plt/S-D） in predicting esophageal varices bleeding （ EGVB ） in hepatitis patients with liver cirrhosis .Methods We enrolled 50 hepatitis patients with liver cirrhosis who received hospitalized treatment in Weifang People′s Hospital Affiliated to Weifang Medical College from January to December 2013.According to whether EGVB occurred , the subjects were divided into two groups： bleeding group （ n=26） and non-bleeding group （ n =24 ） .We analyzed and compared SAAG , PVD and Plt/S-D between the two groups .The ROC curves of SAAG, PVD, Plt/S-D and their combined application predicting EGVB in hepatitis patients with liver cirrhosis was drawn.Results （1） The two groups were significantly different （P〈0.01） in SAAG, PVD and Plt/S-D; non-conditional logistic regression analysis showed that SAAG , PVD and Plt/S-D had significant influence （ P〈0.05 ） on EGVB in hepatitis patients with liver cirrhosis . （ 2 ） The areas under ROC curves of SAAG , PVD and Plt/S-D predicting EGVB in hepatitis patients with liver cirrhosis were 0.74, 0.81 and 0.67 respectively.When the value of SAAG was 20.50 g/L, the corresponding sensitivity was 80.8%and the specificity was 58.3%; when the value of SAAG was 20.10 g/L, the corresponding sensitivity was 65.4%and the specificity was 62.5%.When the value of PVD was 13.50 mm, the corresponding sensitivity was 80.8%and the specificity was 66.3%; when the value of PVD was 14.25 mm, the corresponding sensitivity was 65.4%and the specificity was 83.3%.When the value of Plt/S-D was 0.88 ×109 个/mm, the corresponding sensitivity was 80.8% and the specificitynbsp;was 66.7%; when the value of Plt/S-D was 0.97 ×109 个/mm, the corresponding sensitivity was 65.4%and the specificity was 66.7%. （ 3 ） The evaluation formula of the combined application of SAAG , PVD and Plt/S-D predicting EGVB in hepatitis patients with liver cirrhosis was found： score of bleeding prediction =SAAG ×PVD ÷Plt/S-D.When the area under ROC was 0.91 and the value was 890.35, we got the highest sensitivity and specificity , which were 87.8% and 90.7%. Gonclusion SAAG, PVD and Plt/S-D are the influencing factors for EGVB in hepatitis patients with liver cirrhosis .The combined application of the three factors has higher value in predicting EGVB in hepatitis patients with liver cirrhosis .