Jeon Seong Woo, Cho Chang Min, Tak Won Young, Ryeom Hun Kyu, Kweon Young Oh, Kim Sung Kook, Choi Yong Hwan
Department of Internal Medicine, Kyungpook National University College of Medicine, Jung-gu, Daegu, Korea.
Korean J Gastroenterol. 2006 Sep;48(3):180-7.
BACKGROUND/AIMS: Upper gastrointestinal endoscopy is usually recommended for the evaluation of esophageal varices in patients with liver cirrhosis. However, the prevalence of varices is extremely variable. We performed this study to determine the predictive values for esophageal varices and to select eligible patients for screening endoscopy.
Fifty-two patients were enrolled in this study. Laboratory tests including liver biochemistry and complete blood count along with ultrasonography with Doppler measurements and endoscopy were performed.
Esophageal varices were present in 25 patients (48%). Variables associated with the presence of esophageal varices on univariate analysis were serum albumin, total bilirubin, prothrombin time and platelet count (p<0.05). Significant variables in ultrasonography with Doppler measurement were diameter of spleen (13.04+/-2.1 cm vs. 10.39+/-1.6 cm, p<0.001), peak velocity of portal vein (30.2+/-7.5 cm/sec vs. 36.1+/-8.0 cm/sec, p<0.01) and portal vein diameter (1.26+/-0.28 cm vs. 1.13+/-0.18 cm, p<0.05). On multivariate analysis, independent variables were platelet count (odds ratio (OR) 0.922; 95% confidence interval (CI), 0.86-0.99), diameter of spleen (OR 5.4; 95% CI, 1.63-17.88) and platelet count/spleen diameter ratio (OR 1.007; 95% CI, 1.01-1.02). The optimal critical value for the diameter of spleen was 11 cm. The sensitivity and specificity with this value were 84% and 63%, respectively.
Doppler measurement was not helpful in distinguishing the presence of varices. However, clinical tests including biochemistry and ultrasonography would be useful in selecting eligible patients for screening endoscopy. Endoscopic screening for esophageal varices is recommended in cirrhotic patients with splenomegaly.
背景/目的：对于肝硬化患者食管静脉曲张的评估，通常推荐进行上消化道内镜检查。然而，静脉曲张的患病率差异极大。我们开展这项研究以确定食管静脉曲张的预测价值，并选择适合进行筛查性内镜检查的患者。
本研究纳入了52例患者。进行了包括肝脏生化检查、全血细胞计数在内的实验室检查，以及多普勒超声检查和内镜检查。
25例患者（48%）存在食管静脉曲张。单因素分析中与食管静脉曲张存在相关的变量有血清白蛋白、总胆红素、凝血酶原时间和血小板计数（p<0.05）。多普勒超声检查中的显著变量有脾脏直径（13.04±2.1 cm对10.39±1.6 cm，p<0.001）、门静脉峰值流速（30.2±7.5 cm/秒对36.1±8.0 cm/秒，p<0.01）和门静脉直径（1.26±0.28 cm对1.13±0.18 cm，p<0.05）。多因素分析中，独立变量为血小板计数（比值比（OR）0.922；95%置信区间（CI），0.86 - 0.99）、脾脏直径（OR 5.4；95% CI，1.63 - 17.88）和血小板计数/脾脏直径比值（OR 1.007；95% CI，1.01 - 1.02）。脾脏直径的最佳临界值为11 cm。此值的敏感性和特异性分别为84%和63%。
多普勒测量对于鉴别静脉曲张的存在并无帮助。然而，包括生化检查和超声检查在内的临床检查对于选择适合进行筛查性内镜检查的患者是有用的。对于有脾肿大的肝硬化患者，建议进行食管静脉曲张的内镜筛查。
