乙型肝炎肝硬化食管静脉曲张无创预测因素探讨

Noninvasive index for diagnosing the degree of esophageal varices in patients with hepatitis B virus-related cirrhosis

目的探讨乙型肝炎肝硬化患者常见无创性指标对食管静脉曲张（EV）的评估价值。方法回顾性分析112例乙型肝炎肝硬化患者的临床资料，依据胃镜检查结果将患者分组，其中无食管静脉曲张（NEV） 30例（NEV组）；有EV 82例（EV组），轻度21例（轻度EV组），中度47例（中度EV组），重度14例（重度EV组）。比较各组年龄、性别、血小板、谷氨酰转肽酶、凝血酶原时间、白蛋白、胆红素、门静脉直径、脾静脉直径及脾脏厚度等，分析各指标与EV的关系。结果NEV组和EV组性别构成、年龄、白蛋白、胆红素、凝血酶原时间、谷氨酰转移酶比较差异无统计学意义（P〉0.05）；EV组门静脉直径、脾静脉直径、脾脏厚度明显高于NEV组[（14.1 ± 3.1）mm比（10.6 ± 2.3）mm、（8.9 ± 2.1）mm比（7.6 ± 1.6）mm、（4.8 ± 0.9）mm比（3.8 ± 1.0）mm]，血小板明显低于NEV组[（86.8 ± 20.2）×10^9/L比（163.5 ± 18.1）×10^9/L］，差异有统计学意义（P〈0.01或〈 0.05）。中度EV组和重度EV组门静脉直径、脾静脉直径及脾脏厚度均高于NEV组和轻度EV组[（13.5 ± 2.1）和（14.8 ± 3.6）mm比（10.6 ± 2.3）和（11.2 ± 3.1）mm、（8.3 ± 2.1）和（9.1 ± 1.1）mm比（7.6 ± 1.6）和（8.1 ± 1.9）mm、（4.7 ± 1.1）和（4.9 ± 0.9）mm比（3.8 ± 1.0）和（4.1 ± 1.2）mm]，血小板明显低于NEV组和轻度EV组[（72.8 ± 11.6）× 10^9/L和（63.8 ± 15.6）×10^9/L比（163.5 ± 18.1）×10^9/L和（100.2 ± 10.3）× 10^9/L]，差异有统计学意义（P 〈0.05）。门静脉内径和血小板判断中度重EV的受试者工作特征曲线下面积分别为0.719和0.735，其对应的临界值分别为14 mm和69 × 10^9/L。结论门静脉内径及血小板可用于预测中重度EV。

Objective To assess the noninvasive index for diagnosing the degree of esophageal varices （EV） in patients with hepatitis B virus （HBV） -related cirrhosis. Methods The clinical data of 112 patients with HBV-related cirrhosis were studied retrospectively. The patients were divided into non-EV （NEV） group （30 cases） and EV group （82 cases） according to the results of gastroscopy. In EV group, there were mild varices in 21 cases （mild EV group）, moderate varices in 47 cases （moderate EV group） and severe varices in 14 cases （severe EV group）. The age, gender, platelets, glutamyl transpeptidase, prothrombin time, albumin, bilirubin, portal vein diameter, spleen vein diameter and thickness of spleen were compared, and the relationship was analyzed between each index and EV. Results There were no statistical differences in gender, age, albumin, bilirubin, prothrombin time and glutamyl transpeptidase between NEV group and EV group （P 〉 0.05）. The portal vein diameter, spleen vein diameter and thickness of spleen in EV group were significantly higher than those in NEV group： （14.1 ± 3.1） mm vs. （10.6 ± 2.3） mm, （8.9 ± 2.1） mm vs. （7.6 ± 1.6） mm and （4.8 ± 0.9） mm vs. （3.8 ± 1.0） mm, the platelets in EV group was significantly lower than that in NEV group： （86.8 ± 20.2） × 10^9/L vs. （163.5 ± 18.1） × 10^9/L, and there were statistical differences （P 〈 0.01 or 〈 0.05）. The portal vein diameter, spleen vein diameter and thickness of spleen in moderate EV group and severe EV group were significantly higher than those that in NEV group and mild EV group： （13.5 ± 2.1） and （14.8 ± 3.6） mm vs. （10.6 ± 2.3） and （11.2 ± 3.1） mm, （8.3 ± 2.1） and （9.1 ± 1.1） mm vs. （7.6± 1.6） and （8.1 ± 1.9） mm, （4.7 ± 1.1） and （4.9 ± 0.9） mrn vs. （3.8 ± 1.0） and （4.1 ± 1.2） mm, the platelet levels were significantly lower than those in NEV group and mild EV group： （72.8± 11.6） × 10^7L and （63.8 ± 15.6） ×10^9/L vs. （163.5 ± 18.1） × 10^9/L and （100.2 ± 10.3） × 10^9/L, and there were statistical differences （P 〈 0.05）. The area under curve of response operating characteristic for predicting the presence of moderate and severe EV with portal vein diameter and platelets were 0.719 and 0.735, and the cut offvalue were 14 mm and 69 × 10^7L. Conclusions The portal vein diameter and platelets can predict the presence of moderate and severe EV in patients with HBV-related cirrhosis.