血氨对肝硬化食管静脉曲张的诊断价值

Diagnostic value of serum ammonia for esophageal varices in cirrhotic patients

目的 探讨血氨在肝硬化食管静脉曲张(EV)中的诊断价值。方法 回顾性分析182例肝硬化患者的临床资料,分析血氨与EV之间的关系,通过受试者工作特征(ROC)曲线评估血氨对EV的诊断效能。结果 单因素分析提示腹水、血小板、白蛋白、总胆红素、凝血时间、血氨、Child-Pugh分级、门静脉直径(PVD)、脾静脉直径(SVD)等在EV组(137例)和非EV组(45例)之间差异均有统计学意义(P均<0.05)。Logistic多因素回归分析提示血氨、PVD、SVD为EV的独立危险因素。根据EV的内镜下特征比较血氨水平,不同的分度(P <0.001)、部位(P=0.004)、形态(P <0.001)、基本色调(P=0.001)、是否有红色征(P <0.001)的血氨水平比较差异均有统计学意义,且分度及形态的级别越高,血氨水平越高。ROC曲线分析结果显示血氨在诊断EV时,曲线下面积为0.904,灵敏度为94.9%,特异度为75.6%。结论 血氨、PVD、SVD为肝硬化EV的独立危险因素,血氨对肝硬化EV诊断效能较高,可作为肝硬化EV的初筛工具。

Objective To evaluate the value of serum ammonia in the diagnosis of esophageal varices(EV) in cirrhotic patients. Methods Clinical data of 182 cirrhotic patients were retrospectively analyzed, and the relationship between serum ammonia and EV was analyzed. The efficiency of serum ammonia in the diagnosis of EV was assessed by the receiver operating characteristic(ROC) curve. Results Univariate analysis indicated that ascites,platelet,albumin,total bilirubin,prothrombin time,ammonia,Child-Pugh classification,portal vein diameter(PVD) and splenic vein diameter(SVD) were statistically significant between the EV and non-EV groups(all P < 0.05). Logistic multivariate regression analysis showed that serum ammonia, PVD and SVD were the independent risk factors for EV. According to endoscopic features of EV, the serum ammonia level showed significant differences regarding the grade(P < 0.001), location(P = 0.004),form(P < 0.001), color(P = 0.001) and red color signs(P < 0.001) of EV.The higher grade and form of EV, the higher serum ammonia level. ROC curve analysis indicated that the area under the ROC curve of serum ammonia in the diagnosis of EV was 0.904, with a sensitivity of 94.9% and a specificity of 75.6%. Conclusions Serum ammonia, PVD and SVD are the independent risk factors for EV in cirrhotic patients. Serum ammonia has high efficiency in the diagnosis of EV, which can be used as a preliminary screening tool for EV in cirrhotic patients.