肝脏硬度测定、血小板计数/脾厚比值和脾静脉直径预测肝硬化并发食管静脉曲张价值研究

Diagnostic performance of liver stiffness measurement,platelet/spleen thickness ratio and splenic vein diameter in predicting esophageal varices in patients with liver cirrhosis

目的探讨肝脏硬度检测(LSM)、血小板计数(PLT)/脾脏厚度(ST)比值和脾静脉直径(SVD)预测肝硬化并发食管静脉曲张(EV)和侧支静脉曲张的效能。方法我院诊治的肝硬化患者94例,接受胃镜、超声内镜和FibroScan502检查。将EV分为无EV(NEV)、轻度EV、中度EV和重度EV。将食管周围静脉曲张(peri-ECV)分为无peri-ECV、轻度peri-ECV和重度peri-ECV,将食管旁侧支静脉曲张(para-ECV)分为无para-ECV、轻度para-ECV和重度para-ECV。应用ROC分析指标预测效能。结果与NEV患者比,中度和重度EV患者ST、SVD和LSM均显著升高(P<0.05),而PLT和PLT/ST比值显著降低(P<0.05);重度peri-ECV患者PLT和PLT/ST比值显著低于无或轻度peri-ECV患者(P<0.05),而SVD和LSM水平显著高于轻度peri-ECV患者(P<0.05);与无para-ECV患者比,轻度和重度para-ECV患者PLT和PLT/ST比值显著降低,而ST、SVD和LSM水平均显著升高(P<0.05);经ROC曲线分析发现LSM诊断EV的AUROC为0.754,显著大于PLT/ST比值或SVD(分别为0.738和0.679);PLT/ST比值、LSM和SVD预测peri-ECV的效能均较低,其AUROC值均<0.600;PLT/ST比值预测para-ECV的效能显著优于LSM或SVD(AUROC为0.794对0.669或0.685)。结论应用LSM预测肝硬化并发EV或应用PLT/ST比值预测食管旁侧支静脉有一定的诊断价值,可在临床用于初筛检查,值得进一步验证。

Objective The aim of this study was to investigate the diagnostic performance of liver stiffness measurement(LSM),platelet count(PLT)/spleen thickness(ST)ratio and splenic vein diameter(SVD)in predicting esophageal varices(EV)in patients with liver cirrhosis(LC).Methods We collected 94 patients with LC,and all patients completed gastroscopy and endoscopic ultrasonography.The EV were divided into non-EV(NEV),mild,moderate,and severe EV,the periesophageal varices(peri ECV)were divided into no peri ECV,mild and severe peri ECV,and the collateral esophageal veins(para-ECV)were divided into non-para-ECV,mild and severe para-ECV.The receiver operating characteristic(ROC)curve was applied to evaluate the predictive performance.Results The ST,SVD and LSM in patients with moderate and severe EV were significantly higher in patients with NEV(P<0.05),and the PLT counts and PLT/ST ratio were significantly lower in with NEV(P<0.05);the PLT and PLT/ST ratio in patients with severe peri-ECV were significantly lower than in patients without or with mild peri-ECV(P<0.05),while the SVD and LSM were significantly higher than in with mild peri-ECV(P<0.05);the PLT counts and PLT/ST ratio in patients with mild and severe para-ECV decreases greatly,while the ST,SVD and LSM increased greatly compared to in patients without para-ECV(P<0.05);the ROC analysis showed that the AUROC was 0.754 by LSM in predicting EV,much superior to PLT/ST ratio or SVD(the AUROCs were 0.738 and 0.679,respectively);the predictive efficacy of PLT/ST ratio,LSM and SVD for peri-ECV were all poor with the AUROCs<0.600;the predictive efficacy of PLT/ST ratio in judging para-ECV was much superior to LSM or SVD(the AUROC was 0.794 vs.0.669 or 0.685).Conclusion The LSM has a certain predictive efficacy for EV,and the PLT/ST ratio also has some efficacy for ECV in patients with LC,which might be applied for screening in clinical practice.