CAJ | 학술논문

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.
목적 탐토응용순시탄성소묘의(FibroScan,FS)검측비장경도대간경화환자식관위저정맥곡장적진단개치.방법 2011년4월지2012년4월천진시제삼중심의원간내과문진혹주원치료적259례간경화환자,동시이30명건강지원자작건강대조조.사용FS측량비장급간장탄성치,259례간경화환자중유201례환자동시진행위경검사.이위경검사결과위금표준회제비장탄성치、간장탄성치급PLT/비후도적공작특정곡선,계산곡선하면적(AUC),평개기대식관위저정맥곡장적예측개치.결과 간경화조환자비장탄성치위(44.64±22.27) kPa,간장탄성치위(24.27±18.89) kPa,대조조비장탄성치(20.94±14.78) kPa,간장탄성치위(6.12±5.77) kPa,간경화조간장탄성치급비장탄성치균고우건강대조조(균P＜0.05).간장급비장탄성치수Child-Pugh분급증가정상승추세,즉간경화정도월중,간장급비장탄성치월고(F=0.068,P=0.000);비장탄성치재Child-Pugh A급、B급여C급비교중차이유통계학의의(P＜0.05).중도급중도식관위저정맥곡장환자비장급간장경도치명현증고,ROC곡선분석비장경도치、간장경도치급PLT/비후도대중-중도식관위저정맥곡장적AUC분별위0.918、0.749화0.743,이령민도화특이도지화적최대치선정적최가계한치분별위50.7 kPa、20.1 kPa화1.65.비장경도치적AUC、령민도급특이도균고우간장경도치급PLT/비후도.결론 응용FS검측비장경도시평개간경화환자식관위저정맥곡장적일충유효적비침입성방법,대간경화환자식관위저정맥곡장적진단화치료구유중요적지도의의.
Objective 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.