无创标志物对原发性胆汁性胆管炎患者食管胃底静脉曲张的预测价值

Predictive value of noninvasive markers for gastroesophageal esophageal varices in patients with primary biliary cholangitis

目的评价无创指标预测原发性胆汁性胆管炎(PBC)患者发生食管胃底静脉曲张的价值。方法回顾性分析2017年1月至2020年9月在中国人民武装警察部队特色医学中心就诊并接受胃镜检查的106例PBC患者的临床资料,以内镜检查为金标准,将患者分为静脉曲张组(n=54)和无静脉曲张组(n=52)。比较患者的生化学、超声检查指标,Logistic回归分析PBC患者发生静脉曲张的独立危险因素,使用受试者工作特征(ROC)曲线分析危险因素预测食管胃底静脉曲张发生的价值。结果106例患者中有54例(50.94%)存在食管胃底静脉曲张。静脉曲张组与无静脉曲张组比较,白蛋白水平更低(P=0.000),白细胞计数更低(P=0.000),血小板计数更低(P=0.000),γ-谷氨酰转肽酶水平更低(P=0.004),胆红素水平更高(P=0.017),脾脏更长(P=0.000),门静脉更宽(P=0.000)。Logistic回归分析显示,门静脉宽度增加、脾脏长度增加、白蛋白水平降低、γ-GT水平降低为PBC患者发生食管胃底静脉曲张的独立危险因素,其中门静脉宽度增大的OR值最大为1.573(P=0.032)。ROC曲线分析提示,门静脉宽度、脾脏长度、白蛋白、γ-GT均可预测PBC患者食管胃底静脉曲张的发生。结论门静脉宽度、脾脏长度、白蛋白、γ-GT可作为预测PBC患者食管胃底静脉曲张发生的无创标志物。

Objective To evaluate the value of non-invasive indexes in predicting gastroesophageal esophageal varices in patients with primary biliary cholangitis(PBC).Methods The clinical data of 106 PBC patients who received gastroscopy in Characteristic Medical Center of Chinese People′s Armed Police Force our hospital from January 2017 to September 2020 were retrospectively analyzed.The patients were divided into gastroesophageal esophageal varices group(n=54)and non-gastroesophagealesophageal varices group(n=52)with endoscopy as the gold standard.The independent risk factors of varices in PBC patients were analyzed by logistic regression.Receiver operating characteristic curve(ROC)was used to analyze the value of risk factors in predicting the occurrence of gastroesophageal esophageal varices.Results A total of 54(50.94%)of 106 patients had gastroesophagealesophageal varices.Patients with gastroesophagealesophageal varices had lower albumin level(P=0.000),lower white blood cell count(P=0.000),lower platelet count(P=0.000),lowerγ-GT(P=0.004),higher bilirubin level(P=0.017),longer spleen(P=0.000)and wider portal vein(P=0.000).Logistic regression analysis showed that the increase of portal vein width,spleen length,albumin level andγ-GT level were the risk factors for gastroesophagealesophageal varices in PBC patients.The largest OR value was 1.573(P=0.027)for increased portal vein width.ROC curve analysis showed that portal vein width,spleen length,albumin andγ-GT could predict the occurrence of gastroesophagealesophageal varices in PBC patients.Conclusion Portal vein width,spleen length,albumin andγ-GTγ-GT can be used as non-invasive markers to judge the occurrence of gastroesophageal esophageal varices in PBC patients.