门静脉流速、血小板计数与脾脏长径比值对乙型肝炎肝硬化食管胃底静脉曲张的预测价值

肝脏 ›› 2024, Vol. 29 ›› Issue (10): 1225-1229.

门静脉流速、血小板计数与脾脏长径比值对乙型肝炎肝硬化食管胃底静脉曲张的预测价值

牛丽娜, 宋贺卫, 赵金库, 李鑫贺, 钟浩义, 徐强, 王晓忠

136200 吉林辽源市人民医院(牛丽娜,宋贺卫,赵金库,李鑫贺);150000 黑龙江哈尔滨医科大学(钟浩义);830000 乌鲁木齐新疆维吾尔自治区中医医院(徐强,王晓忠)

收稿日期:2023-08-22 出版日期:2024-10-31 发布日期:2024-12-02
通讯作者: 王晓忠,Email:wxz125@sina.com
基金资助:
新疆维吾尔自治区自然科学基金项目(2022D01C173);国家自然科学基金(81760832);乐德行全国名中医工作室

Predictive value of portal vein velocity, platelet count/spleen diameter ratio for esophageal fundus varices in patients with hepatitis B-related cirrhosis

NIU Li-na¹, SONG He-wei¹, ZHAO Jin-ku¹, LI Xin-he¹, ZHONG Hao-yi², XU Qiang³, WANG Xiao-zhong³

1. Liaoyuan People's Hospital, Jilin 136200, China;
2. Harbin Medical University, Heilongjiang 150000, China;
3. Xinjiang Medical University Affiliated Hospital of Traditional Chinese Medicine, Urumqi 83000, China

Received:2023-08-22 Online:2024-10-31 Published:2024-12-02
Contact: WANG Xiao-zhong,Email:wxz125@sina.com

摘要/Abstract

摘要： 目的探讨门静脉流速(PVV)、血小板计数与脾脏长径比值(PC/SD)对乙型肝炎肝硬化患者发生食管胃底静脉曲张(EGV)的预测价值。方法选取2021年6月—2023年4月于新疆维吾尔自治区中医医院就诊的临床资料完整并行电子胃镜、肝胆脾+门静脉彩超的乙型肝炎相关肝硬化患者127例,按电子胃镜检查结果分为EGV组75例和无EGV组52例。对EGV组的影响因素行单因素分析,再以二元 logistic 回归分析EGV的无创预测指标,并绘制受试者工作特征(ROC)曲线评价各指标预测EGV的价值。计算曲线下面积(AUC)及其截断值以及相应敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)。结果单因素分析发现EGV组与无EGV组的PVV(t=-4.421)、PC(Z=-5.654)、SD(t=-5.163)、PC/SD(Z=5.585)、AST(Z=-4.005)、CHE(t=6.864)、Alb(t=7.248)、TBil(t=-6.668)、INR(t=-8.889)、APRI指数(Z=-6.372)、肝硬化分期(χ²=52.307)、腹水(χ²=26.057)、肝性脑病(χ²=7.435)、Child-Pugh分级(χ²=83.923)比较差异均有统计学意义(均P<0.001);使用二分类logistic回归分析结果显示PVV(OR:1.426, 95%CI:1.172~1.735)是乙型肝炎肝硬化合并EGV的独立危险因素;PC/SD(OR:0.148,95%CI:0.065～0.337)是乙型肝炎肝硬化合并EGV的保护因素^[1];PVV预测乙型肝炎肝硬化合并EGV的AUC为0.718,截断值为21.5时,其预测敏感性为77.3%,特异性为44.2%,阳性预测值为66.7%,阴性预测值为57.5%;PC/SD预测EGV的AUC为0.812,截断值为0.721时,其预测敏感性为84.0%,特异性为57.7%,阳性预测值为74.1%,阴性预测值为71.4%。结论 PVV、PC/SD均对乙型肝炎肝硬化合并EGV具有较好的预测价值。

关键词: 食管胃底静脉曲张, 乙型肝炎肝硬化, 门静脉流速, 血小板计数, 脾脏长径

Abstract: Objective To investigate the prognostic value of portal vein velocity (PVV), platelet count (PC) to splenic diameter (SD) ratio (PC/SD) for esophagogastric varices (EGV) in patients with hepatitis B-related cirrhosis. Methods A total of 127 patients with hepatitis B-related cirrhosis who received medical treatment in Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine from June 2021 to April 2023 with complete clinical data included electronic gastroscopy, hepatobiliary spleen ultrasound, and portal vein color ultrasound were selected. They were divided into an EGV group of 75 patients and a non-EGV group of 52 patients according to the results of electronic gastroscopy. Univariate analysis was performed on the influencing factors of EGV group, and then binary logistic regression was used to analyze the non-invasive predictive indicators of EGV, and the receiver operating characteristic (ROC) curve was drawn to evaluate the value of each indicator in predicting EGV. The area under the curve (AUC) and its truncation value were calculated, as well as the corresponding sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results Univariate analysis showed statistical differences in the following variables between the two groups, including PVV (t=-4.421), PLT (Z=-5.654), SD (t=-5.163), PC/SD (Z=5.585), AST (Z=-4.005), CHE (t=6.864), Alb (t=7.248), TBil (t=-6.654),INR (t=-8.889), APRI index (Z=-6.372), liver cirrhosis stage (χ²=52.307), ascites (χ²=26.057), hepatic encephalopathy (χ²=7.435), Child-Pugh classification (χ²=83.923), and all P values were less than 0.001. Binary logistic regression analysis showed that PVV (OR:1.426, 95%CI: 1.172~1.735) was an independent risk factor for EGV in patients with hepatitis B-related liver cirrhosis. PC/SD (OR:0.148,95%CI: 0.065-0.337) was a protective factor for EGV. The AUC of PVV in predicting EGV in patients with hepatitis B cirrhosis was 0.718, with the cut-off value of 21.5. And the model's predictive sensitivity and specificity was 77.3% and 44.2%, respectively. The positive predictive value was 66.7%, and the negative predictive value was 57.5%. When the AUC of PC/SD for predicting EGV was 0.812 and the cut-off value was 0.721, its predictive sensitivity was 84.0%, the specificity was 57.7%, the positive predictive value was 74.1%, and the negative predictive value was 71.4%. Conclusion Both PVV and PC/SD have good predictive value for EGV in patients with hepatitis B cirrhosis.

Key words: Esophagogastric varices, Hepatitis B cirrhosis, Portal vein velocity, Platelet counter, Splenic length

牛丽娜, 宋贺卫, 赵金库, 李鑫贺, 钟浩义, 徐强, 王晓忠. 门静脉流速、血小板计数与脾脏长径比值对乙型肝炎肝硬化食管胃底静脉曲张的预测价值[J]. 肝脏, 2024, 29(10): 1225-1229.

NIU Li-na, SONG He-wei, ZHAO Jin-ku, LI Xin-he, ZHONG Hao-yi, XU Qiang, WANG Xiao-zhong. Predictive value of portal vein velocity, platelet count/spleen diameter ratio for esophageal fundus varices in patients with hepatitis B-related cirrhosis[J]. Chinese Hepatolgy, 2024, 29(10): 1225-1229.

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参考文献

[1] 张孟杰, 曹晓凌. 食管胃底静脉曲张破裂出血内镜治疗的研究进展[J]. 中国当代医药,2023,30(07):45-48.
[2] 朱会明, 张华, 张金荣, 等. 肝硬化血瘀证患者食管胃底静脉曲张相关性研究[J]. 中国中医急症,2023,32(04):665-668.
[3] 封爽, 冯慧芬, 徐晶, 等. 肝硬度值和血小板计数/脾脏厚径比率对肝硬化食管胃底静脉曲张程度的预测价值[J]. 临床肝胆病杂志,2021,37(12):2819-2823.
[4] Kayacetin E, Efe D, Dogan C. Portal and splenic hemodynamics incirrhotic patients: relationship between esophageal variceal bleeding and the severity of hepatic failure[J]. Gastroenterol,2004,39:661-667.
[5] Soliman LA, Zayed RA, Omran D, et al. Apelin Association with Hepatic Fibrosis and Esophageal Varices in Patients with Chronic Hepatitis C Virus[J]. Am J Trop Med Hyg,2022,107(1):190-197.
[6] 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会消化内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 中华内科杂志,2023,62(01):7-22.
[7] Zironi G, Gaiani S, Fenyves D, et al. Value of measurement of mean portal flow velocity by Doppler flowmetry in the diagnosis of portal hypertension[J]. Hepatol,1992,16:298-303.
[8] Afsar A, Nadeem M, Shah SAA, et al. Platelet count can predict the grade of esophageal varices in cirrhotic patients: a cross-sectional study[J]. F1000Res,2021,10:101.
[9] Lesmana CRA, Raharjo M, Gani RA. Managing liver cirrhotic complications: Overview of esophageal and gastric varices[J]. Clin Mol Hepatol,2020,26(4):444-460.
[10] Agha A, Anwar E, Bashir K, et al. External validation of the platelet count /spleen diameter ratio for the diagnosis of esophageal varices in hepatitis C virus-related cirrhosis[J]. Dig Dis Sci,2009,54(3):654-660.
[11] 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[J]. Cochrane Database Syst Rev,2017,4(4):008759.
[12] 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[J]. Gastroenterol Res Pract,2017:7407506.
[13] Liu H, Zhang Q, Gao F, et al. Platelet Count/Spleen Thickness Ratio and the Risk of Variceal Bleeding in Cirrhosis With Esophagogastric Varices[J]. Front Med (Lausanne),2022,9:870351.
[14] 陈颖, 方青青, 陈炜, 等. 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(02):164-168.
[15] 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[J]. Gut,2003,52(8):1200-1205.
[16] 宗莉, 姜晓燕, 张瑞. 乙型肝炎肝硬化患者脾切除断流术后门脉血栓形成危险因素分析[J]. 社区医学杂志,2021,19(03):162-165.