常规无创指标对肝硬化患者食管静脉曲张的诊断价值

The diagnostic value of routine non-invasive indicators for esophageal varices in patients with liver cirrhosis

目的探讨一些常规无创指标对肝硬化患者食管静脉曲张(EV)的诊断价值。方法选取我院消化内科2015年8月~2019年9月住院行电子胃镜检查的肝硬化患者221例为研究对象,根据电子胃镜检查结果分为无/轻EV组(n=83)与中/重EV组(n=138)。收集患者血常规、肝功能、凝血功能、彩超等检查结果,探讨其对肝硬化患者EV的诊断价值。结果单因素分析显示,两组患者门静脉主干内径、PLT、AST、ALB、PT、PTA、APRI评分、腹水差异有统计学意义(P<0.05)。二分类Logistic回归分析显示,门静脉主干内径(OR=2.007,P<0.001)、ALB(OR=0.931,P=0.01)、APRI评分(OR=2.189,P<0.001)为有统计学意义的指标。ROC曲线结果显示,门静脉主干内径、APRI评分、ALB的AUC分别为0.789、0.797、0.346,绘制门静脉主干内径+APRI评分的ROC曲线显示AUC为0.874。结论门静脉主干内径联合APRI评分对肝硬化中/重度EV有较高的诊断价值,对病毒性肝炎肝硬化所致的中/重度EV诊断价值可能更好。

Objective To explore the diagnostic value of routine non-invasive indicators for esophageal varices(EV)in patients with liver cirrhosis.Methods 221 patients with cirrhosis admitted to the department of gastroenterology at the second affiliated hospital of Zhengzhou university from August 2015 to September 2019 and underwent electronic gastroscopy were selected.All patients were divided into no or light EV group(83 cases)and moderate or severe EV group(138 cases),according to the results of electronic gastroscopy.The results of blood routine examination,liver function,coagulation function,color Doppler ultrasound and other examinations were collected to investigate the diagnostic value of EV in liver cirrhosis.Results There were significant differences in portal vein diameter,PLT,AST,ALB,PT,PTA,APRI score and ascites between the two groups(P<0.05).Binary Logistic regression analysis showed that the portal vein diameter(OR=2.007,P<0.001),ALB(OR=0.931 P=0.01),and APRI score(OR=2.189,P<0.001)were statistically significant.ROC curve results showed that the AUC of portal vein diameter,APRI score and ALB were 0.789,0.797 and 0.346 respectively.Drawing the ROC curve of the portal vein diameter+APRI score showed that the AUC was 0.874.Conclusion The portal vein diameter combined with APRI score has higher diagnostic value for moderate and severe EV in liver cirrhosis.It may have better diagnostic value for moderate and severe EV caused by hepatitis cirrhosis.