Fagundes Eleonora Druve Tavares, Ferreira Alexandre Rodrigues, Roquete Mariza Leitão Valadares, Penna Francisco José, Goulart Eugênio Marcos Andrade, Figueiredo Filho Paulo Pimenta, Bittencourt Paulo Fernando Souto, Carvalho Simone Diniz, Albuquerque Walton
Department of Pediatrics, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
J Pediatr Gastroenterol Nutr. 2008 Feb;46(2):178-83. doi: 10.1097/MPG.0b013e318156ff07.
To determine the clinical and laboratory parameters that may predict the presence of esophageal varices in children and adolescents with portal hypertension.
Overall, 111 patients with portal hypertension and no previous history of digestive bleeding underwent esophagogastroduodenoscopy for detection of esophageal varices. A univariate analysis initially was carried out, followed by a logistic regression analysis to identify the independent variables associated with the presence of esophageal varices. Sensitivity and specificity rates, positive predictive value, negative predictive value, and the accuracy of the predictive variables identified among cirrhotic patients were calculated with the esophagogastroduodenoscopy as the reference test.
Sixty percent of patients had esophageal varices on the first esophagogastroduodenoscopy. Patients with portal vein thrombosis and congenital hepatic fibrosis were 6.15-fold more likely to have esophageal varices than cirrhotic patients. When we analyzed 85 cirrhotic patients alone, splenomegaly and hypoalbuminemia remained significant indicators of esophageal varices. Only spleen enlargement showed appropriate sensitivity and negative predictive value (97.7% and 91.7%, respectively) to be used as a screening test for esophageal varices among cirrhotic patients.
In reference services and research protocols, endoscopic screening should be performed in all patients with portal vein thrombosis and congenital hepatic fibrosis. Among cirrhotic patients, the indication should be conditioned to clinical evidence of splenomegaly or hypoalbuminemia. For clinicians, the recommendation is to emphasize the orientations given to guardians of patients with portal vein thrombosis and congenital hepatic fibrosis as to the risk of digestive bleeding. Cirrhotic patients with hypoalbuminemia and splenomegaly should receive the same orientations.
确定可能预测门静脉高压症儿童及青少年食管静脉曲张存在的临床和实验室参数。
总共111例门静脉高压症且无前驱消化出血史的患者接受了食管胃十二指肠镜检查以检测食管静脉曲张。首先进行单因素分析，随后进行逻辑回归分析以确定与食管静脉曲张存在相关的独立变量。以食管胃十二指肠镜检查作为参考测试，计算肝硬化患者中所确定的预测变量的敏感度、特异度、阳性预测值、阴性预测值及准确度。
首次食管胃十二指肠镜检查时60%的患者有食管静脉曲张。门静脉血栓形成和先天性肝纤维化患者发生食管静脉曲张的可能性比肝硬化患者高6.15倍。单独分析85例肝硬化患者时，脾肿大和低白蛋白血症仍是食管静脉曲张的重要指标。仅脾肿大显示出合适的敏感度和阴性预测值（分别为97.7%和91.7%），可作为肝硬化患者食管静脉曲张的筛查测试。
在参考服务和研究方案中，应对所有门静脉血栓形成和先天性肝纤维化患者进行内镜筛查。对于肝硬化患者，筛查指征应视脾肿大或低白蛋白血症的临床证据而定。对于临床医生而言，建议向门静脉血栓形成和先天性肝纤维化患者的监护人强调有关消化出血风险的指导意见。低白蛋白血症和脾肿大的肝硬化患者应接受同样的指导意见。
