脾硬度及血小板计数联合脾脏大小在肝硬化食管胃底静脉曲张诊断中的应用

Application of spleen stiffness and platelet count plus spleen size in the diagnosis of gastroesophageal varices in liver cirrhosis

目的探讨脾硬度(SSM)、血小板计数(PLT)联合脾脏大小对肝硬化食管胃底静脉曲张(GOV)的诊断价值。方法选取109例在我院就诊的乙型肝炎肝硬化病人,超声测量其脾脏厚径(ST)和脾脏长径(SD),应用瞬时弹性扫描仪测量其SSM,并进行血清学检测及胃镜检查。以胃镜检查结果为标准,采用Logistic回归分析乙型肝炎肝硬化中-重度GOV与SSM、PLT/SD、PLT/ST的关系,建立回归模型。结果有、无GOV组SSM、PLT/ST、PLT/SD比较差异有统计学意义(Z=3.03~5.53,P<0.05)。建立判断中-重度GOV的回归模型Logit(P)=-6.373+0.298×SSM-0.443×PLT/ST。SSM、PLT/ST、PLT/SD及回归模型诊断中-重度GOV的受试者工作特征曲线下面积分别为0.94、0.79、0.77、0.95。结论SSM、PLT/ST、PLT/SD对肝硬化是否存在GOV有一定的诊断价值,且SSM诊断中度以上GOV的价值比PLT/ST和PLT/SD更高;SSM及PLT联合脾脏大小建立的无创诊断模型也可用于诊断中-重度GOV。

Objective To investigate the value of spleen stiffness measurement(SSM)and platelet count(PLT)combined with spleen size for the diagnosis of gastroesophageal varices(GOV)in patients with liver cirrhosis.Methods We included 109 patients with hepatitis B cirrhosis admitted to our hospital.They underwent ultrasonography for spleen thickness(ST)and spleen diameter(SD)and transient elastography for SSM as well as serological examination and gastroscopy.A Logistic regression analysis was performed to analyze the relationship between moderate-to-severe GOV and SSM,PLT/SD,and PLT/ST in patients with hepatitis B cirrhosis.Results There were significant differences in SSM,PLT/ST,and PLT/SD between the patients with GOV and those without GOV(Z=3.03-5.53,P<0.05).The regression model for determining moderate-to-severe GOV was as following:Logit(P)=-6.373+0.298×SSM-0.443×PLT/ST.The areas under the receiver operating characteristic curves of SSM,PLT/ST,PLT/SD,and the regression model for diagnosing moderate-to-severe GOV were 0.94,0.79,0.77,and 0.95,respectively.Conclusion SSM,PLT/ST,and PLT/SD have certain value for determining the presence or absence of GOV in liver cirrhosis,and SSM is superior to PLT/ST and PLT/SD in predicting moderate-to-severe GOV.The model combining SSM,PLT,spleen size can be an invasive alternative for the diagnosis of moderate-to-severe GOV.