Levy Cynthia, Zein Claudia O, Gomez Justin, Soldevila-Pico Consuelo, Firpi Roberto, Morelli Giuseppe, Nelson David
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Florida, Gainesville, Florida 32608, USA.
Clin Gastroenterol Hepatol. 2007 Jul;5(7):803-8. doi: 10.1016/j.cgh.2007.02.031. Epub 2007 Jun 4.
BACKGROUND & AIMS: Esophageal varices and bleeding are among the most feared complications of primary biliary cirrhosis (PBC). We aimed to determine the prevalence of esophageal varices in patients with PBC, to evaluate noninvasive markers of esophageal varices in this population, and to validate the results in an independent set of patients.
Data were collected on all patients with PBC seen for the first time at the University of Florida (study group) and at Case Western Reserve University hospitals (cross-validation group) during 7 consecutive years. Logistic regression analysis was used to identify independent predictors of esophageal varices. The best cut-off values were calculated based on receiver operating characteristic curves. The diagnostic accuracy of the independent predictors of esophageal varices identified in the study group were retested in the cross-validation group.
Of 210 patients with PBC seen at the University of Florida, 113 had an endoscopy and 49.6% (56 of 113) were found to have esophageal varices. After excluding 22 patients with a history of variceal bleeding, data on 91 patients were analyzed. Thirty-four patients had esophageal varices (37%). Multivariate analysis revealed that a platelet count of less than 140,000 (odds ratio, 7.6; 95% confidence interval, 1.6-37) and a Mayo risk score of 4.5 or greater (odds ratio, 10.6; 95% confidence interval, 1.8-62) were independent predictors of esophageal varices. The diagnostic accuracy of these predictors was confirmed in an independent set of patients.
Among patients with PBC, a platelet count of less than 140,000 and/or a Mayo risk score of 4.5 or greater appears to identify those patients more likely to benefit from a screening endoscopy.
食管静脉曲张及出血是原发性胆汁性肝硬化（PBC）最可怕的并发症之一。我们旨在确定PBC患者食管静脉曲张的患病率，评估该人群中食管静脉曲张的非侵入性标志物，并在一组独立患者中验证结果。
收集了连续7年在佛罗里达大学（研究组）和凯斯西储大学医院（交叉验证组）首次就诊的所有PBC患者的数据。采用逻辑回归分析确定食管静脉曲张的独立预测因素。根据受试者工作特征曲线计算最佳临界值。在交叉验证组中重新测试研究组中确定的食管静脉曲张独立预测因素的诊断准确性。
在佛罗里达大学就诊的210例PBC患者中，113例接受了内镜检查，其中49.6%（113例中的56例）发现有食管静脉曲张。排除22例有静脉曲张出血史的患者后，对91例患者的数据进行了分析。34例患者有食管静脉曲张（37%）。多因素分析显示，血小板计数低于140,000（比值比，7.6；95%置信区间，1.6 - 37）和梅奥风险评分4.5或更高（比值比，10.6；95%置信区间，1.8 - 62）是食管静脉曲张的独立预测因素。这些预测因素的诊断准确性在一组独立患者中得到了证实。
在PBC患者中，血小板计数低于140,000和/或梅奥风险评分4.5或更高似乎可识别出更可能从筛查性内镜检查中获益的患者。
