无创评估食管静脉曲张的存在和大小

IF 0.2 4区医学 Q4 MEDICINE, GENERAL & INTERNAL

Vojnosanitetski pregled Pub Date : 2023-01-01 DOI:10.2298/vsp220915008p

G. Petrovic, A. Nagorni, G. Bjelakovic, Daniela Benedeto-Stojanov, Biljana Radovanović-Dinić

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引用次数: 0

摘要

介绍/目标。相当数量的肝硬化患者接受筛查内窥镜检查，没有食管静脉曲张(EV)或有不需要预防性治疗的静脉曲张。考虑到手术的侵入性，需要发展非内窥镜方法来预测EV的存在是合理的。本研究的目的是确定临床、生化和超声参数在预测EV中的意义。方法。该研究包括59例肝硬化患者，39例(66.1%)EV患者和20例(33.9%)无EV患者。在EV组中，小EV 22例(56.4%)，大EV 17例(46.3%)。临床参数包括Child Pough (CP)评分、腹水和脾肿大。所有参与者均进行全血细胞计数、肝功能检查、腹部超声和胃镜检查，并计算血小板计数/脾直径比(PC/SD)。结果。单因素logistic回归分析显示，发生EV的独立危险因素为:CP B级(OR 6.67, p=0.003)和CP C级(OR 23.33, p=0.005)相对于A级、腹水(OR 7.78, p= 0.001)、脾脏大小(OR 1.035, p= 0.016)、胆红素(OR 1.065, p=0.007)、白蛋白(OR 0.794, p= 0.001)、凝血酶原时间(PT) (OR 0.912, p<0.001)、INR (OR 231.364, p<0.001)、血小板计数?Plc (OR 0.989, p= 0.023)， PC/SD比(OR0.999, p=0.034)。在多变量模型中，Plc降低是EV存在的统计学显著危险因素(OR 0.983, p =0.023)。白细胞减少和右肝叶大小是发生大EV的有统计学意义的因素。根据PC/SD比的ROC曲线，得到检验的截断值为- 907(907.11)，对大EV的负预测值为76.4%。结论。PC/SD截断值< 907对大EV的发生有预测价值。

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Noninvasive assessment of the presence and size of esophageal varices

Introduction/Aim. A significant number of patients with liver cirrhosis who underwent screening endoscopy do not have esophageal varices (EV) or have varices that do not require prophylactic therapy. Given the invasiveness of the procedure, the need to develop non-endoscopic methods in predicting the presence of EV is reasonable. The aim of the study was to determine the significance of clinical, biochemical and ultrasonic parameters in the prediction of EV. Methods. The study included 59 patients with cirrhosis of the liver, 39 (66.1%) patients with EV and 20 (33.9%) patients without EV. In the group of patients with EV, 22 (56.4%) patients had small EV and 17 (46.3%) patients had large EV. Clinical parameters that included Child Pough (CP) score, ascites, and splenomegaly were evaluated. In all participants, complete blood count, liver function tests, abdominal ultrasound and gastroscopy were performed, and a platelet count/spleen diameter ratio (PC/SD) was calculated. Results. Univariate logistic regression analysis showed that independent risk factors for the occurrence of EV were: CP B class (OR 6.67, p=0.003) and CP C class (OR 23.33, p=0.005) relative to class A, ascites (OR 7.78, p =0.001), spleen size (OR 1.035, p =0.016), bilirubin (OR 1.065, p=0.007), albumin (OR 0.794, p =0.001), protrombin time (PT) (OR 0.912, p<0.001), INR (OR 231.364, p <0.001), platelet count? Plc (OR 0.989, p =0.023), PC/SD ratio (OR0.999, p=0.034). In a multivariate model, it was shown that a decreased Plc was a statistically significant risk factor for the presence of EV (OR 0.983, p =0.023). Leukopenia and the size of the right liver lobe were found to be statistically significant factors for the occurrence of large EV. Based on the ROC curve for the PC/SD ratio, the cut-off value of the test was obtained - 907 (907.11), with a negative predictive value of 76.4% for large EV. Conclusion. The cut-off value of PC/SD < 907 has a predictive value for the occurrence of large EV.

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