中华传染病杂志
中華傳染病雜誌
중화전염병잡지
CHINESE JOURNAL OF INFECTIOUS DISEASES
2014年
2期
111-115
,共5页
刘芳%李隽%韩涛%向慧玲%张洪生
劉芳%李雋%韓濤%嚮慧玲%張洪生
류방%리준%한도%향혜령%장홍생
无创评分系统%乙肝肝硬化%食管静脉曲张%食管静脉曲张出血%脾硬度%肝硬度%瞬时弹性扫描仪
無創評分繫統%乙肝肝硬化%食管靜脈麯張%食管靜脈麯張齣血%脾硬度%肝硬度%瞬時彈性掃描儀
무창평분계통%을간간경화%식관정맥곡장%식관정맥곡장출혈%비경도%간경도%순시탄성소묘의
Noninvasive score system%Hepatitis B virus-related cirrhosis%Esophageal varices%Esophageal varices bieeding%Spleen stiffness%Liver stiffness%Fibroscan
目的 回顾性分析以瞬时弹性成像技术(TE)、血清学检测和影像学检查指标为基础的简易无创评分系统对乙型肝炎肝硬化患者食管静脉曲张出血的诊断价值.方法 2011年4月至2012年12月天津市第三中心医院肝内科门诊或住院的乙型肝炎肝硬化患者172例,其中男120例,女52例,平均年龄(52.9±10.6)岁.用胃镜观察患者有无食管静脉曲张,若有食管静脉曲张,按食管静脉曲张形态及出血危险程度分轻、中、重3级.采用TE中的Fibroscan进行肝脏硬度及脾脏硬度检测.彩色多普勒超声检查患者门静脉宽度、脾静脉宽度和脾脏厚度.同时检测患者白细胞和血小板计数.运用受试者工作特征(ROC)曲线及曲线下面积(AUC)判断以肝脏硬度、脾脏硬度、脾脏厚度等为基础的简易无创评分系统对食管静脉曲张破裂出血的评估价值.两样本均数比较采用t检验,相关性分析采用Pearson相关分析.结果 172例患者均行胃镜检查,其中首次食管静脉曲张出血患者41例,食管静脉曲张未出血患者131例.172例患者中无食管静脉曲张39例,轻度食管静脉曲张30例,中度食管静脉曲张47例,重度食管静脉曲张56例.食管静脉曲张出血与肝脏硬度值、脾脏硬度值、门静脉宽度、脾脏厚度、脾静脉宽度呈正相关(r值分别为0.224、0.771、0.214、0.425和0.364,均P＜0.05),与血小板计数呈负相关(r=-0.408,P=0.000),与白细胞计数无关(r=0.126,P=0.215).食管静脉曲张出血患者肝脏硬度值、脾脏硬度值、门静脉宽度、脾脏厚度和脾静脉宽度均明显高于未出血患者,而血小板计数低于未出血患者,差异均有统计学意义(均P＜0.05).简易无创评分系统预测食管静脉曲张及出血的AUC分别为0.953和0.882,最佳界值分别为7分和10分(均P=0.000),其诊断食管静脉曲张的敏感度为96％,特异度为85％,诊断食管静脉曲张破裂出血的敏感度为78％,特异度为89％.结论 应用以肝硬度、脾硬度、脾脏厚度、脾静脉宽度、门静脉宽度、血小板计数为基础的简易无创评分系统对乙型肝炎肝硬化食管静脉曲张出血的诊断具有重要的指导意义,可作为临床筛选方法.
目的 迴顧性分析以瞬時彈性成像技術(TE)、血清學檢測和影像學檢查指標為基礎的簡易無創評分繫統對乙型肝炎肝硬化患者食管靜脈麯張齣血的診斷價值.方法 2011年4月至2012年12月天津市第三中心醫院肝內科門診或住院的乙型肝炎肝硬化患者172例,其中男120例,女52例,平均年齡(52.9±10.6)歲.用胃鏡觀察患者有無食管靜脈麯張,若有食管靜脈麯張,按食管靜脈麯張形態及齣血危險程度分輕、中、重3級.採用TE中的Fibroscan進行肝髒硬度及脾髒硬度檢測.綵色多普勒超聲檢查患者門靜脈寬度、脾靜脈寬度和脾髒厚度.同時檢測患者白細胞和血小闆計數.運用受試者工作特徵(ROC)麯線及麯線下麵積(AUC)判斷以肝髒硬度、脾髒硬度、脾髒厚度等為基礎的簡易無創評分繫統對食管靜脈麯張破裂齣血的評估價值.兩樣本均數比較採用t檢驗,相關性分析採用Pearson相關分析.結果 172例患者均行胃鏡檢查,其中首次食管靜脈麯張齣血患者41例,食管靜脈麯張未齣血患者131例.172例患者中無食管靜脈麯張39例,輕度食管靜脈麯張30例,中度食管靜脈麯張47例,重度食管靜脈麯張56例.食管靜脈麯張齣血與肝髒硬度值、脾髒硬度值、門靜脈寬度、脾髒厚度、脾靜脈寬度呈正相關(r值分彆為0.224、0.771、0.214、0.425和0.364,均P＜0.05),與血小闆計數呈負相關(r=-0.408,P=0.000),與白細胞計數無關(r=0.126,P=0.215).食管靜脈麯張齣血患者肝髒硬度值、脾髒硬度值、門靜脈寬度、脾髒厚度和脾靜脈寬度均明顯高于未齣血患者,而血小闆計數低于未齣血患者,差異均有統計學意義(均P＜0.05).簡易無創評分繫統預測食管靜脈麯張及齣血的AUC分彆為0.953和0.882,最佳界值分彆為7分和10分(均P=0.000),其診斷食管靜脈麯張的敏感度為96％,特異度為85％,診斷食管靜脈麯張破裂齣血的敏感度為78％,特異度為89％.結論 應用以肝硬度、脾硬度、脾髒厚度、脾靜脈寬度、門靜脈寬度、血小闆計數為基礎的簡易無創評分繫統對乙型肝炎肝硬化食管靜脈麯張齣血的診斷具有重要的指導意義,可作為臨床篩選方法.
목적 회고성분석이순시탄성성상기술(TE)、혈청학검측화영상학검사지표위기출적간역무창평분계통대을형간염간경화환자식관정맥곡장출혈적진단개치.방법 2011년4월지2012년12월천진시제삼중심의원간내과문진혹주원적을형간염간경화환자172례,기중남120례,녀52례,평균년령(52.9±10.6)세.용위경관찰환자유무식관정맥곡장,약유식관정맥곡장,안식관정맥곡장형태급출혈위험정도분경、중、중3급.채용TE중적Fibroscan진행간장경도급비장경도검측.채색다보륵초성검사환자문정맥관도、비정맥관도화비장후도.동시검측환자백세포화혈소판계수.운용수시자공작특정(ROC)곡선급곡선하면적(AUC)판단이간장경도、비장경도、비장후도등위기출적간역무창평분계통대식관정맥곡장파렬출혈적평고개치.량양본균수비교채용t검험,상관성분석채용Pearson상관분석.결과 172례환자균행위경검사,기중수차식관정맥곡장출혈환자41례,식관정맥곡장미출혈환자131례.172례환자중무식관정맥곡장39례,경도식관정맥곡장30례,중도식관정맥곡장47례,중도식관정맥곡장56례.식관정맥곡장출혈여간장경도치、비장경도치、문정맥관도、비장후도、비정맥관도정정상관(r치분별위0.224、0.771、0.214、0.425화0.364,균P＜0.05),여혈소판계수정부상관(r=-0.408,P=0.000),여백세포계수무관(r=0.126,P=0.215).식관정맥곡장출혈환자간장경도치、비장경도치、문정맥관도、비장후도화비정맥관도균명현고우미출혈환자,이혈소판계수저우미출혈환자,차이균유통계학의의(균P＜0.05).간역무창평분계통예측식관정맥곡장급출혈적AUC분별위0.953화0.882,최가계치분별위7분화10분(균P=0.000),기진단식관정맥곡장적민감도위96％,특이도위85％,진단식관정맥곡장파렬출혈적민감도위78％,특이도위89％.결론 응용이간경도、비경도、비장후도、비정맥관도、문정맥관도、혈소판계수위기출적간역무창평분계통대을형간염간경화식관정맥곡장출혈적진단구유중요적지도의의,가작위림상사선방법.
Objective To retrospectively analyze the diagnostic value of a noninvasive score system based on transient elastography (TE),serological test and imaging examination on esophageal variceal bleeding (EVB) in patients with hepatitis B virus (HBV)-related cirrhosis.Methods Between April 2011 and December 2012,172 patients with HBV-related cirrhosis including 120 males and 52 females who visited clinic or hospitalized at the Department of Hepatology,Tianjin Third Central Hospital,were retrospectively enrolled.The mean age was (52.9 ± 10.6) years.Patients underwent upper gastrointestinal endoscopy to evaluate esophageal varices (EV) and were further categorized into three stages of mild,moderate and severe according to the morphology of EV and the risk of bleeding.Liver stiffness and spleen stiffness measurement were performed using Fibroscan.Portal vein width,splenic width and spleen thickness were measured using color Doppler ultrasound.All the patients were tested for white blood cell counts and platelet counts.With endoscopy as the gold standard,receiver operating characteristic (ROC) curves and the areas under curves (AUC) were used to assess the performance of the noninvasive score system in predicting EV by liver stiffness,spleen stiffness,portal vein width,spleen thickness and platelet counts.Student's t-test was performed to determine differences between continuous variables.Pearson's correlation was used to evaluate the association between EVB and these parameters.Results All these 172 patients underwent endoscopy.Among them,41 were EVB patients and 131 with no bleeding of EV.Among 172 EV patients,39 without EV,30 were mild EV,47 were moderate EV and 56 were severe EV.EVB was all positively correlated with liver and spleen stiffness,portal vein width,spleen thickness,splenic vein width (r=0.224,0.771,0.214,0.425 and 0.364,respectively; all P＜0.05).EVB was negatively correlated with platelet counts (r=-0.408,P=0.000).Liver stiffness,spleen stiffness,portal vein width,spleen thickness and splenic vein width in EVB patients were significantly higher than those in EV patients (P＜0.05).In contrast,platelet counts level was lower in EVB patients with difference of statistical significance (P＜0.05).AUC of non-invasive score system for EV and EVB were 0.953 and 0.882,respectively (P＜0.05).The optimal cut-off level of noninvasive score system for prediction of EV and EBV were 7 (sensitivity:96 ％,specificity:85 ％) in EV patients and 10 (sensitivity:78％,specificity:89 ％) in EVB patients.Conclusion Non-invasive score system based on liver stiffness,spleen stiffness,spleen thickness,width of splenic and portal vein and platelet counts is of clinical importance in assessing the presence of EV in patients with HBV-related cirrhosis,which is higher clinically valuable in the diagnosis for EV.
