血小板计数与脾脏直径比值对乙型肝炎肝硬化高危食管胃静脉曲张的预测价值

肝脏 ›› 2022, Vol. 27 ›› Issue (2): 164-168.

血小板计数与脾脏直径比值对乙型肝炎肝硬化高危食管胃静脉曲张的预测价值

陈颖, 方青青, 陈炜, 张君佩, 沈丹杰, 李煜, 简佑容, 李锋, 王剑, 陈世耀

201199 上海复旦大学附属闵行医院消化科(陈颖,方青青,陈炜,张君佩,沈丹杰,李煜,简佑容);复旦大学附属中山医院消化科(李锋,王剑,陈世耀)

收稿日期:2021-10-30 出版日期:2022-02-28 发布日期:2022-04-19
通讯作者: 陈世耀,Email:syaochen@fudan.edu.cn
基金资助:
上海市卫生健康委员会先进适宜技术推广项目(2019SY028);闵行区卫生健康委员会科研课题(2020MW52)

The predictive value of PC/SD ratio in evaluating the high-risk gastroesophageal varices in patients with hepatitis B virus-related cirrhosis

CHEN Ying¹, FANG Qing-qing¹, CHEN Wei¹, ZHANG Jun-pei¹, SHEN Dan-jie¹, YU Li¹, JIAN You-rong¹, LI Feng^1,2, WANG Jian^1,2, CHEN Shi-yao^1,2

1. Department of Gastroenterology and Hepatology, Minhang Hospital,Fudan University,Shanghai 201199,China;
2. Department of Gastroenterology and Hepatology, Zhongshan Hospital,Fudan University,Shanghai 200032,China

Received:2021-10-30 Online:2022-02-28 Published:2022-04-19
Contact: CHEN Shi-yao,Email:syaochen@fudan.edu.cn

摘要/Abstract

摘要： 目的探讨血小板计数与脾脏直径比值(PC/SD)对乙型肝炎肝硬化高危食管胃底静脉曲张的预测价值。方法回顾性分析2018年1月至2020年12月在复旦大学附属闵行医院消化内科接受内镜检查的乙型肝炎肝硬化患者的临床资料,按肝脏疾病严重程度与内镜下食管胃底静脉曲张严重程度分为高危组与低危组,对于高危食管胃底静脉曲张的影响因素行单因素分析,发现差异性后再行logistic回归分析筛选无创预测指标,采用受试者工作特征曲线下面积(AUC)评价其诊断效能。结果最终纳入68例乙型肝炎肝硬化患者,单因素分析发现高危组与低危组患者的PC/SD(t=4.141)、血红蛋白(t=2.829)、血小板计数(t=3.324)、有无腹水(χ²=6.530)、肝功能Child-Pugh分级(χ²=6.348)、肝硬化分期(χ²=24.882)等指标比较差异有统计学意义(均P<0.05)。多因素分析结果显示PC/SD(OR=0.998,95%CI:0.996~1.000,P<0.05)和肝硬化分期(OR=14.088,95%CI:3.220~61.629,P<0.01)是乙型肝炎肝硬化高危食管胃底静脉曲张的独立危险因素。PC/SD水平预测乙型肝炎肝硬化高危食管胃底静脉曲张的AUC为0.781,95%CI:0.551~0.811,最佳阈值为596。PC/SD预测无食管胃底静脉曲张的AUC为0.888,95%CI:0.802~0.973,(P<0.01),最佳阈值为632.7。结论 PC/SD可作为临床医师判断乙型肝炎肝硬化人群中筛查高危食管胃底静脉曲张的初筛工具。若PC/SD比值小于596,发生高危食管胃底静脉曲张的可能大,建议胃镜评估食管胃底静脉曲张严重程度。若PC/SD比值大于632.7,合并食管胃底静脉曲张的可能性小,可避免非必要的胃镜筛查。

关键词: 乙型肝炎肝硬化, 食管胃底静脉曲张, 血小板计数与脾脏直径比值, 筛查

Abstract: Objective To investigate the value of platelet count to spleen diameter (PC/SD) ratio in predicting the high-risk gastroesophageal varices (GEV) in patients with hepatitis B virus (HBV)-related cirrhosis. Methods The patients with HBV-related cirrhosis from January 2018 to December 2020 were divided into a high-risk group and a low-risk group, according to the severity of liver disease and endoscopic performance. The influencing factors of high-risk GEV were analyzed by univariate analysis. Then logistic regression analysis was used to screen out the non-invasive indicators, and diagnostic efficiency were evaluated by receiver operator characteristic (ROC) curve. Results A total of 68 patients were enrolled. Univariate analysis showed that the differences of PC/SD ratio (t=4.141,P<0.01), hemoglobin (t=2.829,P<0.01), platelet count (t=3.324,P<0.01), ascites (χ² = 6.530,P<0.05), Child-Pugh classification (χ² = 6.348,P<0.05) and cirrhosis stages (χ² = 24.882,P<0.01) between the high-risk group and low-risk group were statistically significant. Multivariate analysis showed that PC/SD ratio and cirrhosis stages were independent risk factors for high-risk GEV in patients with HBV-related cirrhosis (OR=0.998, 95%CI: 0.996-1.000, P<0.05;OR=14.088, 95%CI: 3.220-61.629, P<0.01). ROC curve analysis showed that the area under the curve (AUC) of PC/SD ratio in predicting high-risk GEV was 0.781 (95%CI: 0.551-0.811), with an optimal threshold of 596. However, the AUC of PC/SD ratio in predicting the absence of high-risk GEV was 0.888 (95%CI: 0.802, 0.973), with an optimal threshold of 632.7. Conclusion PC/SD ratio could be a preliminary screening indicator for GEV in patients with HBV-related cirrhosis. If PC/SD ratio is less than 596, endoscopy is recommended due to the high possibility of high-risk GEV. If the PC/SD ratio is over 632.7, endoscopy screening could be avoided due to the low possibility of high risk GEV.

Key words: HBV-related cirrhosis, Gastroesophageal varices, Platelet count to spleen diameter ratio, Screening

陈颖, 方青青, 陈炜, 张君佩, 沈丹杰, 李煜, 简佑容, 李锋, 王剑, 陈世耀. 血小板计数与脾脏直径比值对乙型肝炎肝硬化高危食管胃静脉曲张的预测价值[J]. 肝脏, 2022, 27(2): 164-168.

CHEN Ying, FANG Qing-qing, CHEN Wei, ZHANG Jun-pei, SHEN Dan-jie, YU Li, JIAN You-rong, LI Feng, WANG Jian, CHEN Shi-yao. The predictive value of PC/SD ratio in evaluating the high-risk gastroesophageal varices in patients with hepatitis B virus-related cirrhosis[J]. Chinese Hepatolgy, 2022, 27(2): 164-168.

参考文献

[1] 中华医学会肝病学分会,中华医学会消化病学分会,中华医学会内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南.临床肝胆病杂志,2016,32:203-219.
[2] 中华医学会外科学分会脾及门静脉高压外科学组.肝硬化门静脉高压症食管胃底静脉曲张破裂出血诊治专家共识(2019版).中华消化外科杂志,2019,18:1087-1093.
[3] Giannini E, Botta F, Borro P, et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis.Gut,2003,52:1200-1205.
[4] Chen R,Deng H, Ding X, et al. Platelet count to spleen diameter ratio for the diagnosis of gastroesophageal varices in liver cirrhosis a systematic review and meta-analysis. Gastroenterol Res Pract,2017,2017:7407506.
[5] Kim BK,Han KH,Park JY,et al.A liver stiffness measurement-based,noninvasive predition model for high-risk esophageal varices in B-viral liver cirrhosis.Am J Gastroenterol, 2010,105:1382-1390.
[6] Wang JH,Chuash SK,Lu SN,et al.Transient elastography and simple blood markers in the diagnosis of esophageal varices for compensated patients with hepatitis B virus-related cirrhosis.J Gastroenterol Hepatol, 2012,27:1213-1218.
[7] Wang J, Wei W, Duan Z,et al.Development and validation of a nomogram for predicting varices needing treatment in compensated advanced chronic liver disease: a multicenter study.Saudi J Gastroenterol,2021,27(6):376-382.
[8] Yang LB,Xu JY,Tantai XX,et al.Non-invasive prediction model for high-risk esophageal varices in the Chinese population.World J Gastroenterol,2020,26: 2839-2851.
[9] Dong TS,Kalani A,Aby ES,et al.Machine learning-based development and validation of a scoring system for screening high-risk esophageal varices.Clin Gastroenterol Hepatol,2019,17:1894-1901.
[10] Colli A,Gana JC,Yap J,et al.Platelet count,spleen length,and platelet count-to-spleen length ratio for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis.Cochrane Database Syst Rev,2017,4 :CD008759.
[11] Ozdil K, Ozturk O, Calik ES, et al. Relationship between size of varices and platelet count/ spleen size ratio in cirrhotic patients. North Clin Istanb, 2016,3: 46-52.
[12] Chawla S, Katz A, Attar BM,et al.Platelet count/spleen diameter ratio to predict the presence of esophageal varices in patients with cirrhosis: a systematic review.Eur J Gastroentero Hepatol, 2012,24:431-436.
[13] Darweesh SK, Elsabaawy MA, Eltahawy MA,et al.Serum ammonia as a non-invasive marker for early prediction of esophageal varices.Eur J Gastroenterol Hepatol, 2021,32:230-236.
[14] González-Ojeda A,Cervantes-Guevara G,Chávez-Sánchez M,et al. Platelet count/spleen diameter ratio to predict esophageal varices in Mexican patients with hepatic cirrhosis.World J Gastroenterol,2014,20:2079-2084.
[15] Kothari HG,Gupta SJ,Gaikwad NR,et al.Role of non-invasive markers in prediction of esophageal varices and variceal bleeding in patients of alcoholic liver cirrhois from central India.Turk J Gastroenterol,2019,30:1036-1043.
[16] Duah A,Nkrumah K, Tachi K, et al. Non-invasive markers as predictors of oesophageal varices in cirrhotic patient in a teaching hospital in Ghana.Ghana Med J,2019,53:142-149.