摘要目的 探讨应用瞬时弹性扫描仪(FibroScan,FS)检测脾脏硬度对肝硬化患者食管胃底静脉曲张的诊断价值.方法 2011年4月至2012年4月天津市第三中心医院肝内科门诊或住院治疗的259例肝硬化患者,同时以30名健康志愿者作健康对照组.使用FS测量脾脏及肝脏弹性值,259例肝硬化患者中有201例患者同时进行胃镜检查.以胃镜检查结果为金标准绘制脾脏弹性值、肝脏弹性值及PLT/脾厚度的工作特征曲线,计算曲线下面积(AUC),评价其对食管胃底静脉曲张的预测价值.结果 肝硬化组患者脾脏弹性值为(44.64±22.27) kPa,肝脏弹性值为(24.27±18.89) kPa,对照组脾脏弹性值(20.94±14.78) kPa,肝脏弹性值为(6.12±5.77) kPa,肝硬化组肝脏弹性值及脾脏弹性值均高于健康对照组(均P＜0.05).肝脏及脾脏弹性值随Child-Pugh分级增加呈上升趋势,即肝硬化程度越重,肝脏及脾脏弹性值越高(F=0.068,P=0.000);脾脏弹性值在Child-Pugh A级、B级与C级比较中差异有统计学意义(P＜0.05).中度及重度食管胃底静脉曲张患者脾脏及肝脏硬度值明显增高,ROC曲线分析脾脏硬度值、肝脏硬度值及PLT/脾厚度对中-重度食管胃底静脉曲张的AUC分别为0.918、0.749和0.743,以灵敏度和特异度之和的最大值选定的最佳界限值分别为50.7 kPa、20.1 kPa和1.65.脾脏硬度值的AUC、灵敏度及特异度均高于肝脏硬度值及PLT/脾厚度.结论 应用FS检测脾脏硬度是评价肝硬化患者食管胃底静脉曲张的一种有效的非侵入性方法,对肝硬化患者食管胃底静脉曲张的诊断和治疗具有重要的指导意义.

abstractsObjective To investigate the value of spleen stiffness measured by transient elastography (FibroScan,FS) for diagnosing esophageal-gastric varices in liver cirrhosis patients.Methods A total of 259 cirrhotic patients in Tianjin Third Central Hospital from Apr 2011 to Apr 2012,and 30 healthy controls were enrolled.All the patients and controls were evaluated for spleen and liver stiffness by FS and 201 cirrhotic patients also underwent gastroscopy for the diagnosis of esophageal-gastric varices.By using gastroscopy as the gold standard,the receiver operating characteristic (ROC) curves of three parameters including spleen stiffness,liver stiffness and platelet/thickness of spleen were delineated for different disease stage.The areas under curves (AUC) were used to evaluate the value of these parameters in the diagnosis of esophageal-gastric varices.Results The spleen and liver stiffness values in cirrhotic patients were (44.64 ± 22.27) kPa and (24.27 ±18.89) kPa,respectively,while those in healthy controls were (20.94± 14.78) kPa and (6.12±5.77) kPa,respectively,which were both lower than cirrhotic patients (P＜0.05).The stiffness values of liver and spleen both increased with higher Child-Pugh scores.And the liver stiffness values were different among groups (F=0.068,P =0.000),while the spleen stiffness values in patients with Child-Pugh A and B were different from that in patients with Child-Pugh C (P＜0.05).In patients with moderate or serious esophageal-gastric varices,the spleen and liver stiffness values were significantly higher.The ROC curve analysis showed that the AUC of spleen stiffness,liver stiffness and platelet/thickness of spleen in the patients with moderate to serious esophageal-gastric varices were 0.918,0.749 and 0.743,respectively.The corresponding optimal cut-off values were 50.7 kPa,20.1 kPa and 1.65.The AUC,sensitivity and specificity of spleen stiffness were all higher than liver stiffness and platelet/thickness of spleen.Conclusion Spleen stiffness measured by transient elastography is a valuable parameter for non-invasive diagnosis of esophageal-gastric varices in cirrhotic patients.