摘要目的 探讨非侵入性检查评估病毒性肝炎肝硬化食管静脉曲张程度的价值.方法 回顾性分析2011年12月至2012年12月就诊于郑州大学第一附属医院的病毒性肝炎肝硬化患者的临床资料,排除患有血液系统疾病、门脉血栓、既往使用β-受体阻滞剂、已行内镜下食管静脉曲张套扎术治疗或脾切除断流术等治疗者.依据内镜检查结果将研究对象分为无/轻度食管静脉曲张组和中/重度食管静脉曲张组,收集血常规、肝功能、凝血功能、彩超检查等结果,采用Logistic回归分析上述观察指标与食管静脉曲张的关系,并用受试者工作特征曲线(ROC曲线)评价它们对食管静脉曲张程度的判别能力.结果 共有96例患者被纳入研究,其中无/轻度食管静脉曲线组30例,中/重度食管静脉曲张组66例.两组间血小板计数(PLT)、血小板压积(PCT)、血小板分布宽度(PDW)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、脾脏厚径(ST)、PLT/ST的差异均有统计学意义(Z/t值=-2.842,-3.151,-2.549.-3.463,-3.601,-4.360和11.877,P＜0.05或0.01).对组间差异有统计学意义的观察指标进行多因素Logistic回归分析,仅发现ST差异有统计学意义(OR=1.127,OR值95％可信区间(CI)为1.012 ～ 1.256,P=0.030).回归方程模型ROC曲线下面积(AUC)为0.728,95％ CI为0.628 ～ 0.827.当ST≥52.5 mm时,诊断食管静脉中/重度曲张的敏感度为53.0％,特异度为90.0％,约登指数为0.43.结论 通过彩超检测病毒性肝炎肝硬化患者ST可实现对食管静脉中/重度曲张的早期筛查诊断.

abstractsObjective To develop a non-invasive method for diagnosis of esophageal varices in patients with cirrhosis induced by viral hepatitis.Methods The clinical data,including results of blood routine,liver function,blood coagulation and color ultrasonography,of patients with cirrhosis induced by viral hepatitis from the First Affiliated Hospital of Zhengzhou University during December 2011 and December 2012 were retrospectively analyzed.Patients with hematopoietic diseases and portal vein thrombosis were excluded,and no patients received beta-blocker,endoscope band ligation,and splenectomy treatment.According to gastroscopic results,all patients were divided into no/mild group and mid/serious group.Correlations between clinical data and esophageal varices were analyzed by Logistic regression method,and receiver operating characteristic (ROC) curve was used to evaluate their values for diagnosis of esophageal varices.Results Totally 96 patients were enrolled in the study,30 without or with mild esophageal varices,and 66 with mid/serious esophageal varices.There were significant differences on platelet (PLT),plateletcrit (PCT),platelet distribution width (PDW),alanine aminotransferase (ALT),aspartate aminotransferase (AST),spleen thickness (ST) and PLT/ST between no/mild group and mid/ serious group (Z/t =-2.842,-3.151,-2.549,-3.463,-3.601,-4.360and 11.877,P＜0.05 or P ＜ 0.01).Multivariate logistic regression analysis showed that only ST was statistically different between two groups (OR =1.127,OR 95％ confidence interval (CI):1.012-1.256,P =0.030).The area under the curve (AUC) was 0.728,and 95％ CI:0.628-0.827.With the cut off value of 52.5 mm,the sensitivity,specificity,and Youden index of ST in diagnosis of esophageal varices were 53.0％,90.0％ and 0.43,respectively.Conclusion ST measured by color ultrosonography can be used for early diagnosis of mid/serious esophageal varices.