原发性胆汁性肝硬化患者食管静脉曲张特点及其无创预测指标研究

Non-invasive predictors of esophageal varices in patients with primary biliary cirrhosis

目的总结原发性胆汁性肝硬化(PBC)患者食管静脉曲张特点,探索食管静脉曲张发生的无创预测指标。方法 2010年1月~2014年12月期间我院住院治疗的122例PBC患者,常规行电子胃镜检查明确食管静脉曲张程度,应用Logistic回归分析血常规、肝功能、凝血功能指标、免疫球蛋白、腹部增强CT血管重建、腹部彩色超声多普勒检查测量门静脉(PV)和脾静脉(SV)直径以及Child-Pugh评分、MELD评分和Mayo评分共18项指标对预测PBC患者食管静脉曲张发生的价值。结果在122例PBC患者中,16例(13%)无食管静脉曲张,106例(87%)存在不同程度的食管静脉曲张;PBC患者有食管静脉曲张与无食管静脉曲张患者Mayo评分、白蛋白、胆碱酯酶、血小板计数、门静脉和脾静脉直径具有统计学差异(P<0.05);多因素分析显示,脾静脉直径在两组之间具有统计学差异(P=0.016);ROC曲线下面积为0.843,当以SV=8.5 mm为截断点时,其诊断存在静脉曲张的灵敏度为72.0%,特异度为92.9%,阳性预测值为98.6%,阴性预测值为31.7%。结论脾静脉内径可较好地预测PBC患者食管静脉曲张发生的风险,而既往国外报道的具有预测价值的血小板计数和Mayo评分在本研究中未显示出预测价值。

Objective To explore the non-invasive predictors of esophageal varices in patients with primary biliary cirrhosis （PBC）. Methods A total of 122 hospitalized PBC patients were retrospectively analyzed in this study. The degree of esophageal varices was judged by endoscopy,and other examinations including routine blood biochemical tests and abdominal ultrasonic as well as computer tomography were conducted. Child-Pugh score, model for end stage liver disease （MELD） score and Mayo score were calculated. Logistic regression analysis was used to identify the predictors of esophageal varices in PBC patients. The best cut-off values were calculated based on receiver operating characteristic curves （ROC）. Results Out of 122 PBC patients,16 （13.0%） were found without,while 106 （87.0%） with mild to severe degree of esophageal varices;Mayo score,albumin, cholinesterase,platelet count and the diameters of portal vein （PV） and splenic vein （SV） between the two groups were found with statistical difference in univariate analysis,but only the diameter of SV was found with statistical difference in the further multivariate analysis;When the cut-off value of SV was set as 8.5 millimeter,the area under ROC was 0.843 and the sensitivity,specificity,positive predictive value and negative predictive value were 72%,92.9%,98.6% and 31.7%,respectively. Conclusions The diameter of SV is the only predictor of esophageal varices in patients with PBC.