Introduction and Aim of the Work: The identification of cirrhotic patients with esophageal varices or other portosystemic collateral by non-invasive means is appealing in that it could decrease the necessity of endosc...Introduction and Aim of the Work: The identification of cirrhotic patients with esophageal varices or other portosystemic collateral by non-invasive means is appealing in that it could decrease the necessity of endoscopic screening. This study was to evaluate the diagnostic utility of venous ammonia level with other ultrasonographic parameters as non-invasive markers for the presence of portosystemic shunts. Patients and methods: The study included 3 groups of Child Pugh class A and early B patients. Group (A): 25 patients with evidence of both esophageal varices and portosystemic collaterals;group (B) 25 patients with neither evidence of varices nor portosystemic collaterals and group (C): 25 patients with evidence of varices but no collaterals. Measurement of venous ammonia level was done for all patients. Results: serum ammonia level was significantly higher in group A (222.8 ± 54 μg/dL) than that in group B (85 ± 21.1 μg/dL) and group C (148.2 ± 19.6 μg/dL). The cut-off value of serum ammonia level 113 μg/dL was a good predictor for the presence of esophageal varices, while the cut-off value of serum ammonia level at 133 μg/dL was a good predictor for the presence of both esophageal varices and abdominal collaterals. Combination of portal vein diameter > 13mm + splenic vein diameter > 8.9mm + ammonia level > 133 μg/dL gives 100% of sensitivity and 96% of specificity for the prediction of the presence of portosystemic shunts. Conclusion: Determination of serum ammonia level, splenic, portal vein and splenic vein diameters are considered as good predictors for the presence of portosystemic shunts in patients with liver cirrhosis.展开更多
文摘Introduction and Aim of the Work: The identification of cirrhotic patients with esophageal varices or other portosystemic collateral by non-invasive means is appealing in that it could decrease the necessity of endoscopic screening. This study was to evaluate the diagnostic utility of venous ammonia level with other ultrasonographic parameters as non-invasive markers for the presence of portosystemic shunts. Patients and methods: The study included 3 groups of Child Pugh class A and early B patients. Group (A): 25 patients with evidence of both esophageal varices and portosystemic collaterals;group (B) 25 patients with neither evidence of varices nor portosystemic collaterals and group (C): 25 patients with evidence of varices but no collaterals. Measurement of venous ammonia level was done for all patients. Results: serum ammonia level was significantly higher in group A (222.8 ± 54 μg/dL) than that in group B (85 ± 21.1 μg/dL) and group C (148.2 ± 19.6 μg/dL). The cut-off value of serum ammonia level 113 μg/dL was a good predictor for the presence of esophageal varices, while the cut-off value of serum ammonia level at 133 μg/dL was a good predictor for the presence of both esophageal varices and abdominal collaterals. Combination of portal vein diameter > 13mm + splenic vein diameter > 8.9mm + ammonia level > 133 μg/dL gives 100% of sensitivity and 96% of specificity for the prediction of the presence of portosystemic shunts. Conclusion: Determination of serum ammonia level, splenic, portal vein and splenic vein diameters are considered as good predictors for the presence of portosystemic shunts in patients with liver cirrhosis.
文摘目的:研究肝硬化非肿瘤性门静脉血栓(portal vein thrombosis,PVT)形成患者的临床特点,分析PVT形成的相关危险因素.方法:回顾性分析昆明医科大学第二附属医院肝病中心2013-09/2014-12资料完整的肝硬化住院患者171例,其中34例肝硬化合并PVT患者作为门静脉血栓组(PVT组),137例肝硬化无血栓患者作为对照组.记录患者临床指标,进行单因素分析和Logistic回归筛选出PVT的独立危险因素.绘制受试者工作曲线(receiver operating characteristic,ROC),计算曲线下面积(area under the curve,AUC),以判断各指标的诊断效能.结果:Logistic回归模型分析显示D-二聚体(D-dimer,DD)(OR=12.021,P=0.001)、门静脉宽度(OR=28.574,P=0.001)、门静脉血流速度(OR=19.568,P=0.002)差异有统计学意义,绘制ROC,门静脉血流速度AUC<0.5,不能用于预测.DD、门静脉宽度AUV分别为0.669、0.742,P<0.05.结论:门静脉宽度、DD是肝硬化PVT形成的危险因素,门静脉直径越大,DD值越高,PVT形成的风险越高.门静脉宽度>1.3 cm或DD>25冚g/mL时,预测发生PVT的敏感性及特异度综合较好.肝硬化患者应注意监测门静脉宽度、DD水平.
