摘要
目的探讨肝硬度×脾脏直径/血小板评分(LSPS)预测肝硬化食管静脉曲张(EV)的临床价值。方法收集2012年10月-2017年8月于保定市第二中心医院就诊的肝硬化患者76例,分为EV组(n=32)和非EV组(n=44)。所有患者行肝功能、血常规、凝血象检查,行胃镜检查有无静脉曲张及程度,行肝硬度检查,并计算肝脏血清学纤维化指标AST与PLT比值(APRI)、FIB-4、LSPS。计量资料2组间比较采用Mann-Whitney U检验,计数资料组间比较采用χ~2检验,相关性分析采用Spearman相关分析。绘制受试者工作特征曲线,选取敏感度和特异度之和最大值对应的LSPS为最佳界值。结果 EV组PLT值低于非EV组(Z=-6. 932,P <0. 01),EV组脾脏直径、肝硬度、LSPS明显高于非EV组(Z值分别为-4. 566、-6. 575、-7. 323,P值均<0. 01);脾脏直径、肝硬度和LSPS与EV的rs分别为0. 537、0. 759、0. 775,P值均<0. 001;中度EV患者LSPS明显高于轻度患者[6. 50(5. 71~9. 20) vs4. 63(2. 12~6. 13),Z=-2. 010,P=0. 044]; LSPS诊断EV的灵敏度为100%,特异度为93. 2%,阳性预测值为91. 4%,阴性预测值为100%,正确率为96. 1%,Youden指数为93. 2%,受试者工作特征曲线下面积及95%可信区间为0. 994(0. 985~1. 004),阈值为1. 59,提示LSPS> 1. 59考虑为肝硬化患者有食管静脉曲张,如<1. 59可暂时不必胃镜检查。结论 LSPS对肝硬化患者有无EV可以提供一定的预测价值。
Objective To investigate the value of liver stiffness - spleen diameter - to - platelet ratio score （ LSPS）in predicting esophagealvarices （ EV）in patients with liver cirrhosis. Methods A total of 76 patients with liver cirrhosis who visited The Second Central Hospital ofBaoding from October 2012 to August 2017 were enrolled and divided into EV group with 32 patients and non - EV group with 44 patients.Blood samples were collected from all patients for liver function test,routine blood test,and coagulation test. Gastroscopy was performed toevaluate the presence or absence of EV and the degree of EV. Liver stiffness was measured,and aspartate aminotransferase - to - platelet ratio index,fibrosis - 4,and LSPS were calculated. The Mann -Whitney U test was used for comparison of continuous data between groups,andthe chi - square test was used for comparison of categorical data between groups. The Spearman correlation analysis was also performed. The receiver operating characteristic （ ROC）curve was plotted to select LSPS corresponding to the maximum sum of sensitivity and specificity as theoptimal cut - off value. Results Compared with the non - EV group,the EV group had a significantly lower platelet count （ Z = - 6. 932,P 〈 0. 01）and significantly higher spleen diameter,liver stiffness,and LSPS （ Z = - 4. 566,- 6. 575,and - 7. 323,all P 〈 0. 01） .Spleen diameter,liver stiffness,and LSPS were positively correlated with EV （ rs= 0. 537,0. 759,and 0. 775,all P 〈 0. 001） . The patients with moderate EV had a significantly higher LSPS than those with mild EV [ 6. 50 （ 5. 71 - 9. 20）vs 4. 63（ 2. 12 - 6. 13） ,Z = - 2. 010,P = 0. 044] . At the optimal cut - off value of 1. 59,LSPS had a sensitivity of 100%,a specificity of 93. 2%,a positive predictive value of91. 4%,and a negative predictive value of 100% in the diagnosis of EV,with an accuracy of 96. 1%,a Youden index of 93. 2%,and an area under the ROC curve of 0. 994 （ 95% confidence interval： 0. 985 - 1. 004） ,sugges
作者
周佳美
班志超
李艳
张晓娟
张咏华
王明蕾
ZHOU Jiamei;BAN Zhichao;LI Yan(Department of Gastroenterology,The Second Central Hospital of Baoding,Zhuozhou,Hebei072750,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2018年第11期2341-2344,共4页
Journal of Clinical Hepatology
基金
保定市科技支撑计划项目(17ZF132)
关键词
肝硬化
食管和胃静脉曲张
诊断
liver cirrhosis
esophageal and gastric varices
diagnosis
