血小板计数与脾面积比值和血小板计数与脾长径比值诊断乙肝肝硬化患者食管静脉曲张的对比研究

Platelet count/spleen area ratio and platelet count/spleen diameter ratio in the diagnosis of esophageal varices in patients with hepatitis B cirrhosis

目的比较血小板计数与脾面积比值(PC/SA)和血小板计数与脾长径比值(PC/SD)诊断乙肝肝硬化患者食管静脉曲张(EV)的价值。方法选取在我院就诊的172例乙肝肝硬化患者,根据胃镜检查结果分为EV组121例和无EV组51例,均行胃镜、血常规及腹部超声检查,采集血小板计数(PC)、脾长径、脾厚径,计算PC/SA和PC/SD。绘制受试者工作特征(ROC)曲线评价PC/SA、PC/SD诊断EV的价值,比较两者诊断效能。结果EV组脾长径和脾厚径均大于无EV组,EV组PC、PC/SA及PC/SD均小于无EV组(均P<0.001)。PC/SA诊断EV的曲线下面积(AUC)为0.846(95%可信区间:0.784~0.897),截断值为10.29时,其诊断敏感性、特异性、阳性预测值及阴性预测值分别为79.4%、76.5%、88.9%、60.9%;PC/SD诊断EV的AUC为0.816(95%可信区间:0.750~0.871),截断值为629.65时,其诊断敏感性、特异性、阳性预测值及阴性预测值分别为87.6%、64.7%、85.5%、68.7%。PC/SA诊断EV的AUC高于PC/SD(0.846 vs.0.816,Z=2.954,P=0.003)。结论PC/SA与PC/SD均可用于诊断乙肝肝硬化患者EV,PC/SA诊断价值更高,具有较好的临床推广应用潜力。

Objective To explore the value of platelet count/spleen area ratio(PC/SA)and platelet count/spleen diameter ratio(PC/SD)in the diagnosis of esophageal varices(EV)in patients with hepatitis B cirrhosis.Methods A total of 172 patients with hepatitis B cirrhosis were enrolled,they were divided into EV group(n=121)and no EV group(n=51)according to gastroscope,all of them were examined by gastroscope,blood routine examination and abdominal ultrasonography.Platelet count(PC),spleen length diameter and spleen thickness diameter were measared.PC/SA and PC/SD were calculated.The value of PC/SA and PC/SD for diagnosis of EV was evaluated by receiver operating characteristic(ROC)curve.The diagnostic efficacy of PC/SA and PC/SD were compared.Results The spleen length diameter and spleen thickness diameter in EV group were significantly larger than those in no EV group,PC,PC/SA and PC/SD in EV group were significantly lower than those in no EV group(all P<0.001).The area under curve(AUC)of PC/SA for diagnosing EV was 0.846(95%CI:0.784~0.897).When the cutoff value was 10.29,the sensitivity,specificity,positive predictive value and negative predictive value were 79.4%,76.5%,88.9%and 60.9%,respectively.The AUC of PC/SD for diagnosis of EV was 0.816(95%CI:0.750~0.871).When the cutoff value was 629.65,the sensitivity,specificity,positive predictive value and negative predictive value were 87.6%,64.7%,85.5%and 68.7%,respectively.The AUC of PC/SA was higher than that of PC/SD(0.846 vs.0.816,Z=2.954,P=0.003).Conclusion PC/SA and PC/SD can be used to screen EV in patients with hepatitis B cirrhosis.PC/SA,with higher accuracy,is worthy of clinical attention and application.