非侵入性因素预测食管静脉曲张的临床研究
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摘要
目的：探讨非侵入性检查预测肝硬化患者食管静脉曲张存在的可行性方法：收集2010年12月至2011年12月收住我院的肝硬化患者共105例,86例患者按胃镜诊断结果分为轻、中,重度食管静脉曲张三组。另外选择19例经胃镜证实无食管静脉曲张的肝硬化患者作为对照组。记录外周血小板计数,超声测量门静脉内径(PV)、脾脏厚度(ST),脾脏长径(SL)；相关数据进行统计学分析,从性别、年龄、病因,肝功能,PC(血小板计数),PV(门静脉内径)、SL(脾脏长径)、ST(脾脏厚度)、SI(脾脏指数)、PC/SL. PC/ST. PC/SⅢ个指标中筛选出对肝硬化食管静脉曲张是否存在具有预测意义的非侵入性指标。通过ROC曲线下的面积的值来评价上述有预测意义的指标的准确性。结果：PC、PC/SL、PC/ST、PC/SⅠ与有无食管静脉曲张及其严重程度有显著相关性。PC/SⅠ是预测食管静脉曲张较理想的非侵入性指标。性别,年龄,病因,肝功能、门静脉内径,脾脏长径,脾脏厚度,脾脏指数对肝硬化食管静脉曲张的发生无显著相关性。结论：血小板数／脾脏指数比值预测有无食管静脉曲张有一定价值,在一定程度上可以减少内镜检查,降低一定医疗费用
Objective Objective to evaluate non-invasive examinations to predict the existence and severity of esophageal varices in patients with hepatic cirrhosis.Methods105cirrhotic patients admitted to our hospital from2010to2011were enrolled.86patients according to endoscopic diagnosis were divided into mild, moderate, severe esophageal varices in three groups.19patients had no varices confirmed by gastroscopy as a control group. Platelet count, ultrasound measurement of portal vein diameter (PV), spleen thickness (ST), spleen length (SL) was recorded.The data were statistically analyzed. Select the indicators which can be used to predict the existence of esophageal varices in hepatic cirrhosis from the following11indicators: sex,age,cause of disease,liver function, PC (platelet count), PV (portal vein), SL (spleen length), ST (spleen thickness), SI (spleen index:spleen length x spleen thickness), PC/SL、PC/ST、PC/SI. The accuracy of all the non-invasive parameters in predicting the presence of varices was evaluated by the area under the receiver operating characteristic (ROC) curvesResult PC, PC/SL、PC/ST、C/SI were significantly associated with the presence of esophageal varices. The PC/SI is the ideal non-invasive index to predict esophageal varices in hepatic cirrhosis. There are no significant relationship between sex,age,cause of disease,liver function, PV (portal vein), SL (spleen length), ST (spleen thickness), SI (spleen index) and the occurrence of esophageal varices in patients with hepatic cirrhosis.Conclusion The platelet count/spleen index could be used to predict the presence of sever esophageal varices. Application of non-invasive means of checking the measures as predicted, may to a certain extent, reduce the endoscopy, reduce certain medical expenses.
Objective Objective to evaluate non-invasive examinations to predict the existence and severity of esophageal varices in patients with hepatic cirrhosis.Methods105cirrhotic patients admitted to our hospital from2010to2011were enrolled.86patients according to endoscopic diagnosis were divided into mild, moderate, severe esophageal varices in three groups.19patients had no varices confirmed by gastroscopy as a control group. Platelet count, ultrasound measurement of portal vein diameter (PV), spleen thickness (ST), spleen length (SL) was recorded.The data were statistically analyzed. Select the indicators which can be used to predict the existence of esophageal varices in hepatic cirrhosis from the following11indicators: sex,age,cause of disease,liver function, PC (platelet count), PV (portal vein), SL (spleen length), ST (spleen thickness), SI (spleen index:spleen length x spleen thickness), PC/SL、PC/ST、PC/SI. The accuracy of all the non-invasive parameters in predicting the presence of varices was evaluated by the area under the receiver operating characteristic (ROC) curvesResult PC, PC/SL、PC/ST、C/SI were significantly associated with the presence of esophageal varices. The PC/SI is the ideal non-invasive index to predict esophageal varices in hepatic cirrhosis. There are no significant relationship between sex,age,cause of disease,liver function, PV (portal vein), SL (spleen length), ST (spleen thickness), SI (spleen index) and the occurrence of esophageal varices in patients with hepatic cirrhosis.Conclusion The platelet count/spleen index could be used to predict the presence of sever esophageal varices. Application of non-invasive means of checking the measures as predicted, may to a certain extent, reduce the endoscopy, reduce certain medical expenses.
引文
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[1] D'Amico G, Pagliaro I, Bosch J. The treatment of portal hyper-tension: ameta analytic review. Hepatology,1995,22(1):332; 354.
[2]汪鸿志,曹世植主编.现代消化性溃疡病学[M].北京人民军医出版社,1999：64-5
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[4]王帅,闻炜.姚鹏等.肝硬化并门脉高压性胃病的临床研究.世界华人消化杂志2006：14(5)：533-5.
[5] LI FH, Hao J, Xia JG etal. Hemodynamic analysis of esophageal varices in patients with liver cirrhosis using color Doppler ultrasound. World J Gastroenterol.2005 Ang7;11(29):4560-5.
[6] el-Zayadi A, Montasser MF, Girgis F, et al. Histological changes of the esophageal mucosa in bleeding versus non-bleeding varices. Endoscopy.1989 Sep,21(5):205-7.
[7] Bhasin DK, Malhi NJ.Variceal bleeding and portal hypertension:muchto learn, much to explore. Endoscopy,2002,34:119-128.
[8]陈永鹏,李小玲,戴琳,等.超声波评分系统与病理学检查诊断代偿性乙型肝炎肝硬化的比较[J].中华肝脏病杂志,2006,14(12)：936-938.
[9] Greig TD, Garden DJ, Carter DC. Prophylatic treatment of patients with esophageal varices:is it ever Indicated [J]. Wold J Surg,1994,26:748.
[10]中华医学会消化内镜学分会.食管胃底静脉曲张内镜下诊断和治疗规范试行方案(2003年).中华消化内镜杂志,2004,21：149-51.
[11]赵曙光,赵保民,黄裕新,等.血小板计数是重度食管胃底静脉曲张的预测因素[J].第四军医大学学报,2001,22(9)：796.
[12]McCormack TT, Sims J, Eyre-Brook I, Kennedy H, Goepel J, Johnson AG, Triger DR. Gastric lesions in portal Hyper tension:inflammatory gastritis or congestive Gastropathy? Gut,1985,26:1226-32.
[13]王小丛,于国良,高普均.肝硬化门静脉和脾静脉血流量与食道静脉曲张的关系.临床肝胆病杂志.2008,16(3)：177-179.
[14]黄雪,谭至柔.肝源性溃疡的病因与临床特征[J].医学综述,2000,6(9)：402.
with liver cirrhosis. WienKlin wochenschr.2005 oct; 117(19-20):711-7.
[15]Chalasani N, Imperiale T F, Ismail A, et al. Predictors of large esophageal varices in patients with cirrhosis[J]. Am J Gastroenterol,1999,94:3285-3291.
[16]姚建华,陈正言.肝硬化患者血小板计数与脾脏厚度变化对食管静脉曲张的评价.肝脏,2005,10(2)：150-151
[17]Watanabe S,Hos omi N, K itade Y, et al. Assessment of the presence and severity of Esophagogastric varices by splenic index in patients with liver cirrhosis[J]. J Comput Assist Tomogr,2000,24:788-794.
[18]Chalasani N, Imperiale TF, Ismail A, S ood G,Carey M, Wilcox CM, Madichetty H, K wo PY,Boyer TD.Predictors of large esophageal varies inpatients with cirrhosis. Am JGastroenterol,1999,94(11):3103-3105.
[19]Jeon S W, Cho CM, Tak WY, et al. The value of Doppler ultrasonography and laboratory tests as non-invasive predictors of the presence of esophageal varices in patients with chronic liver disease [J]. Korean J Gastroenterol,2006,48:180-187.
[20]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 esophageal varices in patients with liver cirrhosis. Gut,2003,52(8):1200-1205.
[21]王天才,乐桂容,梁扩寰.彩色多普勒超声显像预测肝硬化食管静脉曲张破裂出血的价值[J].临床肝胆病杂志,2002,18(2)：120-121.
[22]刘杰,张健,范妍.非侵入性检查预测食道静脉曲张的临床研究.赣南医学院学报.2005,25(6)：777-778.
[23]白平平,朴云峰,秦俊杰.非侵入性指标预测中重度食管静脉曲张的临床研究.中国厂矿医学.2008,21(3)：267-268
[24]Merli M, Nicolini G, Angeloni S, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol,2003, 38:266-72.
[25]Amitrano L, Guardascione M A, et al. Coagulation abnormalities in cirrhotic patients With portal vein thrombosis [J]. Clin Lab,2007, 53(9-12):583-589.
[26]非侵入性指标预测肝硬化食管静脉曲张存在的临床研究 张海云《吉林大学硕士论文》2009-03-01
[27]Seewald S,Seitz U,Yang AM, et al. Variceal bleeding and portal hypertension:still at herapeutic challenge? Endoscopy,2001,33:126-139.
[2]Brandenburger LA, Regenstein FG. Variceal hemorrhage, Curr Treat OptionsGastroen-terol,2002,5:73-80.
[3]Greig TD, Garden DJ, Carter DC.Prophylatic treatment of patients with esophageal varices:is it ever Indicated[J]. Wold J Surg,1994,26:748.
[4]刘杰,张健,范妍.非侵入性检查预测食道静脉曲张的临床研究.赣南医学院学报.2005,25(6)：777-778.
[5]白平平,朴云峰,秦俊杰.非侵入性指标预测中重度食管静脉曲张的临床研究.中国厂矿医学.2008,21(3)：267-268
[6]Seewald S, Seitz U, Yang AM, et al. Variceal bleeding and portal hypertension:still at herapeutic challenge? Endoscopy,2001,33:126-139.
[7]Bhasin DK, Malhi NJ. Variceal bleeding and portal hypertension:muchto learn, much to explore. Endoscopy,2002,34:119-128.
[8]Wu J, Chan F. Esophageal bleeding disorders. Curr Opin Gastroenterol,2004, 20(4):386-390.
[9]Tsokos M, Turk EE. Esophageal variceal hemorrhage presenting as sudden death in out patients. Arch Pat hoi Lab Med,2002,126:1197-1200.
[10]中华医学会消化内镜学分会.食管胃底静脉曲张内镜下诊断和治疗规范试行方案(2003年).中华消化内镜杂志,2004,21：149-51.
[11]王笑秋,王兴鹏.肝硬化门脉高压患者上消化道出血病因分析[J].临床荟萃,2002,17(8)：455-456.
[12]Smart HL, Triger DR. Clinical features, path physiology and relevance of portal hypertensive gastropathy [J]. Endoscopy,1991,23(4):224-228.
[13]Schepis F, Camma C, Niceforo D, et al. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection. Hepatology,2001,33:333-8.
[14]Merli M, Nicolini G, Angeloni S, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol,2003, 38:266-72.
[15]漆德芳.肝硬化[M].北京：北京科学技术出版社,2000：670-671,675-676.
[16]McCormack TT, Sims J, Eyre-Brook I, Kennedy H, Goepel J, Johnson AG, Triger
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