原发性胆汁性肝硬化食管静脉曲张患者相关指标的临床价值

Clinical value of related indexes in patients with primary biliary cirrhosis with esophageal varices

目的 了解预测原发性胆汁性肝硬化（PBC）患者出现食管静脉曲张的临床指标.方法 回顾性分析2013年1月至2016年12月新疆医科大学第一附属医院PBC患者351例,其中食管静脉曲张173例,无静脉曲张178例.比较两组患者的ALT、AST、碱性磷酸酶（ALP）、γ-GT、TBil、白蛋白、PT、血小板计数、AST与ALT比值（AAR）、基于4因子的肝纤维化指标（FIB-4）、AST与血小板比值指数（APRI）和Mayo评分.正态分布的计量资料以x-±s表示,非正态分布的以M（P25,P75）表示;组间比较采用成组t检验或秩和检验.单因素分析上述检测指标与食管静脉曲张的相关性,多因素非条件Logistic回归分析筛选可独立预测PBC患者出现食管静脉曲张的临床指标.结果 PBC食管静脉曲张患者年龄、PT、TBil、AAR、FIB-4、APRI和Mayo评分高于无食管静脉曲张患者,分别为（60.3±10.6）岁比（51.9±10.9）岁、（13.31±3.12） s比（11.17±2.42） s、28.06（18.05,60.06） mmol/L比15.39（10.64,33.63） μmol/L、1.69±0.91比1.23±0.95、6.18（4.05,9.16）比1.80（1.10,2.74）、1.95（1.12,3.08）比0.69（0.38,1.57）和6.45±1.52比4.62±1.53;而ALT、γ-GT、白蛋白和血小板计数水平低于无食管静脉曲张患者,分别为36.60（19.88,74.28） U/L比59.32（23.58,132.70）U/L、71.00（38.36,165.38） U/L比125.00（37.50,336.21）U/L、（29.78±6.33） g/L比（39.51±25.16）g/L和（103.43±52.84）×10^9/L比（234.44±90.40）×10^9/L,差异均有统计学意义（t=-7.25、t=-7.18、Z=-5.823、t=-4.60、Z=-8.427、Z=-12.661、t=-11.25、Z=-3.218、Z=-2.987、t=4.94、t=16.63,均P〈0.01）.多因素非条件Logistic回归结果显示：血小板计数〈149×10^9/L（OR=0.966,95%CI：0.957～0.974）、PT〉11.95 s（OR=0.705,95%CI：0.569～0.874）、TBil〉17.19 μmol/L（OR=0.99,95%CI：0.982～0.999）、FIB-4〉3.02（OR=0.868,95%CI：0.807～0.932）和Mayo评分〉4.88（OR=6.053,95%CI：2.388～15.342）为预测食管静脉曲张独立的临床指标.结论 血小板计数、PT、TBil、FIB-4和Mayo评分可作为预测PBC患者食管静脉曲张的临床指标.

Objective To investigate the clinical indicators which can predict esophageal varices in patients with primary biliary cirrhosis （PBC）.Methods A total of 351 patients with PBC from the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2016 were retrospectively analyzed, including 173 patients with esophageal varices and 178 patients without varicose veins.The alanine aminotransferase （ALT）, aspartate transaminase （AST）, alkaline phosphatase （ALP）, γ-glutamyl transpeptadase （γ-GT）, total bilirubin （TBil）, albumin （Alb）, prothrombin time （PT）, platelet （PLT）, AST to ALT ratio （AAR）, fibrosis index based on the 4 fator （FIB-4）, AST to PLT ratio index （APRI） and Mayo scores were compared between two groups.Group t test or rank sum test was used to compare the two groups.Relation between the indicators mentioned above and esophageal varices were tested by univariate analysis.Multivariate unconditional Logistic regression was used to screen these indicators to independently predict esophageal varices in PBC patients.Results Age, PT, TBil, AAR, FIB-4, APRI and Mayo scores of PBC patients with esophageal varices were all higher than those of patients without esophageal varices （[60.3±10.6] years old vs [51.9±10.9] years old, [13.31±3.12] s vs [11.17±2.42] s, 28.06 [18.05, 60.06] mmol/L vs 15.39 [10.64, 33.63] μmol/L, 1.69±0.91 vs 1.23±0.95, 6.18 [4.05,9.16] vs 1.80 [1.10,2.74], 1.95 [1.12,3.08] vs 0.69 [0.38,1.57], 6.45±1.52 vs4.62±1.53, respectively）.Whereas ALT, γ-GT, Alb and PLT levels were all lower than those without varicose veins （36.60 [19.88, 74.28] U/L vs 59.32 [23.58, 132.70] U/L, 71.00 [38.36, 165.38] U/L vs 125.00 [37.50, 336.21] U/L, [29.78±6.33] g/L vs [39.51±25.16] g/L, [103.43±52.84]×10^9/L vs [234.44±90.40]×10^9/L, respectively）.The differences were all statistically significant （t=-7.25, t=-7.18, Z=-5.823, t=-4.60, Z=-8.427, Z=-12.661, t=-11.25, Z=-3.218, Z=2.987, t=4.94, t=16.63, respectively;all P〈0.01）.Multivariate unconditional logistic regression analysis showed that PLT〈149×10^9/L （OR=0.966, 95% CI： 0.957-0.974）, PT〉11.95 s （OR=0.705, 95%CI： 0.569-0.874）, TBil〉17.19 μmol/L （OR=0.99, 95%CI： 0.982-0.999）, FIB-4〉3.02 （OR=0.868, 95% CI： 0.807-0.932） and Mayo score〉4.88 （OR=6.053, 95%CI： 2.388-15.342） were independent clinical indicators for the prediction of esophageal varicose veins.Conclusions PLT, PT, TBil, FIB-4, and Mayo scores can be used as predictors of esophageal varices in patients with PBC.