Barikbin R, Hekmatnia A, Omidifar N, Farghadani M, Adibi P
Department of Radiology, Isfahan University of Medical Science, Iran.
Minerva Gastroenterol Dietol. 2010 Mar;56(1):1-6.
It is currently recommended that all patients with liver cirrhosis undergo upper gastrointestinal endoscopy (UGIE) to identify those who have esophageal varices (EV) that carry a high risk of bleeding and may benefit from prophylactic measures. In the future, this social and medical burden will increase due to the greater number of patients with chronic liver disease and their improved survival. The aim of this paper was assess value of platelet count/spleen diameter ratio (PC/SD ratio) for the prediction or screening of EV in cirrhotic patients.
In this two years prospective study, patients with liver cirrhosis referred to Al -Zahra hospital enrolled. Patients underwent detailed clinical examination, blood tests (hematology, liver function tests) and ultrasonography. Size of esophageal varices was assessed at UGIE; Paquet's grades 0-III were classified as group A (0-I; No or Mild EV) and group B (II-III; Moderate to severe EV). PC/SD ratio was also measured as possible noninvasive predictive/screening tools. Degree of eEV was assessed at UGIE. The relationship of the presence and degree of EVs with PC/SD ratio was evaluated.
Fifty consecutive cirrhotic patients (mean age+/-SD) was 52.1 (+/-16.2); 41 male and 9 female) were enrolled; nineteen 19 (38%) patients were placed in group A (No or mild EV) while 31 (62%) had endoscopic evidence of moderate to severe EV (group B). PC/SD ratio cut off value of 921 had 93% negative predictive value. PC/SD ratio found to be significantly (P<0.05) different between group of A and B.
The PC/SD ratio is independently associated with the presence of EV and can predict its severity in patients with cirrhosis. Use of this cost effective parameter may help identify patients with mild or no EV who may not need UGIE to reduce costs and discomfort for these patients and the burden on health system.
目前建议所有肝硬化患者接受上消化道内镜检查（UGIE），以识别那些患有食管静脉曲张（EV）且出血风险高、可能从预防措施中获益的患者。未来，由于慢性肝病患者数量增加及其生存率提高，这种社会和医疗负担将会加重。本文的目的是评估血小板计数/脾脏直径比值（PC/SD比值）在肝硬化患者中预测或筛查食管静脉曲张的价值。
在这项为期两年的前瞻性研究中，纳入了转诊至阿尔-扎赫拉医院的肝硬化患者。患者接受了详细的临床检查、血液检查（血液学、肝功能检查）和超声检查。在UGIE时评估食管静脉曲张的大小；将帕克分级0-III级分为A组（0-I级；无或轻度食管静脉曲张）和B组（II-III级；中度至重度食管静脉曲张）。PC/SD比值也作为可能的非侵入性预测/筛查工具进行测量。在UGIE时评估食管静脉曲张的程度。评估食管静脉曲张的存在和程度与PC/SD比值的关系。
连续纳入50例肝硬化患者（平均年龄±标准差为52.1（±16.2）；41例男性和9例女性）；19例（38%）患者被归入A组（无或轻度食管静脉曲张），而31例（62%）有中度至重度食管静脉曲张的内镜证据（B组）。PC/SD比值截断值为921时，具有93%的阴性预测值。发现A组和B组之间的PC/SD比值有显著差异（P<0.05）。
PC/SD比值与食管静脉曲张的存在独立相关，并且可以预测肝硬化患者食管静脉曲张的严重程度。使用这个具有成本效益的参数可能有助于识别轻度或无食管静脉曲张的患者，这些患者可能不需要UGIE，从而降低这些患者的费用和不适以及卫生系统的负担。
