血小板计数与脾脏上下径比值预测原发性胆汁性胆管炎患者并发食管胃静脉曲张效能研究*

doi:10.3969/j.issn.1672-5069.2022.03.015

实用肝脏病杂志 ›› 2022, Vol. 25 ›› Issue (3): 363-366.doi: 10.3969/j.issn.1672-5069.2022.03.015

血小板计数与脾脏上下径比值预测原发性胆汁性胆管炎患者并发食管胃静脉曲张效能研究^*

钟欢, 叶伟

210000 南京市南京中医药大学附属南京市第二医院肝病科

收稿日期:2021-09-13 出版日期:2022-05-10 发布日期:2022-05-17
通讯作者: 叶伟,E-mail:yewei@njucm.edu.cn
作者简介:钟欢,男,31岁,硕士研究生,住院医师。主要从事肝硬化并发门脉高压诊治研究。E-mail:zhonghuan0000@126.com
基金资助:
^*江苏省青年医学重点人才培养项目(编号:QNRC2016060)

Platelet count/spleen length ratio in predicting gastroesophageal varices in patients with primary biliary cholangitis

Zhong Huan, Ye Wei

Department of Liver Disease, Second Hospital, Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China

Received:2021-09-13 Online:2022-05-10 Published:2022-05-17

摘要/Abstract

摘要： 目的探讨预测原发性胆汁性胆管炎(PBC)患者并发食管胃静脉曲张(GOV)的非侵入性指标,以减少不必要的胃十二指肠内镜(EGD)筛查。方法 2016年1月～2020年12月我院住院的PBC患者67例,均接受了EGD和超声检查,其中32例接受肝活检,33例接受了肝脏硬度检测(LSM)。计算血小板(PLT)计数/脾脏上下径比值(PSR)。应用ROC曲线判断指标的预测效能。结果在67例PBC患者中,发现存在GOV者27例(轻度7例,中度7例,重度13例),无GOV者40例;在32例接受肝组织学检查者中,9例S_3～4与23例S_1～2患者并发GOV者均为3例(Fisher 确切概率法,P=0.203);在33例接受了LSM检查者中,以LSM＞20 kPa为截断点,其预测发生GOV的灵敏度、特异度和准确度分别为100.0%、54.2%和66.7%;多因素Logistic分析提示PSR是PBC患者并发GOV的独立危险因素;以PSR<0.734×10⁹/L/mm为截断点,其预测并发GOV的ROC曲线下面积(AUC)为0.932,其灵敏度、特异度和准确度分别为92.6%、87.5%和89.6%,并可节省92.5%的EGD检查。结论应用PSR预测PBC患者并发GOV有一定的诊断效能,需要更大规模的临床试验验证。

关键词: 原发性胆汁性胆管炎, 食管胃静脉曲张, 血小板计数/脾脏上下径比值, 诊断

Abstract: Objective The aim of this study was to explore an non-invasive indicators for the prediction of gastroesophageal varices (GOV) in patients with primary biliary cholangitis (PBC). Methods A total of 67 patients with PBC were encountered in our hospital between January 2016 and December 2020, and all patients underwent esophagogastroduodenoscopy and ultrasonography. 32 patients received liver biopsies (LB) and 33 received liver stiffness measurement (LSM). The platelet count/spleen length ratio (PSR) were calculated. The prediction was carried out based on the area under the receiver operating characteristic curve (AUC). Results Out of the 67 patients with PBC in our series, 27 patients had GOV (mild in 7, moderate in 7 and severe in 13 cases) and 40 hadn’t; in 32 patients underwent LB, the liver fibrosis S_3-4 was found in 9 cases, S_1-2 was found in 23, and the GOV were found 3 cases in the former and in the latter (Fisher’s, P=0.203); in 33 patients with LSM results, the sensitivity (Se),specificity (Sp) and accuracy (Ac) were 100.0%, 54.2% and 66.7% in predicting GOV occurrence when the LSM＞20 kPa was set as the cut-off-value; the multivariate Logistic analysis showed the PSR was an independent risk factor for GOV happening; the AUC was 0.932, with the Se, Sp and Ac of 92.6%, 87.5% and 89.6% in predicting GOV occurrence when the PSR<0.734×10⁹/L/mm was set as the cut-off-value, and preventing 92.5% of patients from EGD examination. Conclusion The predictive efficacy of our established PSR is promising in predicting GOV in patients with PBC, which might be validated in clinical practice.

Key words: Primary biliary cholangitis, Gastroesophageal varices, Platelet counts/spleen length ratio, Non-invasive diagnosis

钟欢, 叶伟. 血小板计数与脾脏上下径比值预测原发性胆汁性胆管炎患者并发食管胃静脉曲张效能研究^*[J]. 实用肝脏病杂志, 2022, 25(3): 363-366.

Zhong Huan, Ye Wei. Platelet count/spleen length ratio in predicting gastroesophageal varices in patients with primary biliary cholangitis[J]. Journal of Practical Hepatology, 2022, 25(3): 363-366.

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血小板计数与脾脏上下径比值预测原发性胆汁性胆管炎患者并发食管胃静脉曲张效能研究^*

Platelet count/spleen length ratio in predicting gastroesophageal varices in patients with primary biliary cholangitis

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