非侵入性方法可预测先天性胆道闭锁行 Kasai 手术后患者的食管静脉曲张。
Non-invasive methods can predict oesophageal varices in patients with biliary atresia after a Kasai procedure.
机构信息
Department of Clinical Medicine, University of Bologna, Italy.
出版信息
Dig Liver Dis. 2011 Aug;43(8):659-63. doi: 10.1016/j.dld.2011.04.006. Epub 2011 May 19.
BACKGROUND
After a Kasai procedure, 70% of patients with biliary atresia develop chronic liver disease with portal hypertension and oesophageal varices.
AIMS
To investigate the role of new non-invasive parameters in predicting the presence of varices in patients with biliary atresia after a Kasai procedure and to identify the cut-off values of these parameters in predicting the presence of varices.
METHODS
31 patients with biliary atresia who had undergone a Kasai portoenterostomy were studied. Clinical, biochemical and abdominal ultrasound examination, liver stiffness measurement (LSM), LSM-spleen diameter to platelet ratio score (LSPS) and upper digestive endoscopy were performed.
RESULTS
15 (47%) patients had oesophageal varices (Group A) and 16 had no varices (Group B). Median values of LSM (kPa) and LSPS were significantly higher in Group A than in Group B (LSM: 17.0 vs. 7.5, respectively; p=0.0001; LSPS: 19.62 vs. 2.94, respectively; p=0.0001). The optimal cut-offs for predicting oesophageal varices were: LSM>10.6 kPa (sensitivity: 87%, specificity: 87.5%, PPV: 87%, NPV: 87.5%, and AUC: 0.92) and LSPS ≥9.2 (sensitivity: 91%, specificity: 92%, PPV: 91%, NPV: 92%, and AUC: 0.96).
CONCLUSIONS
Non-invasive methods can predict the presence of oesophageal varices in patients with biliary atresia; the sequential use of two non-invasive methods improves accuracy.
背景
胆道闭锁患者在接受葛西手术后，有 70%会发展为伴有门静脉高压和食管静脉曲张的慢性肝病。
目的
探讨新的非侵入性参数在预测葛西手术后胆道闭锁患者是否存在静脉曲张中的作用，并确定这些参数预测静脉曲张存在的临界值。
方法
对 31 例已行葛西吻合术的胆道闭锁患者进行研究。进行临床、生化和腹部超声检查、肝脏硬度测量（LSM）、LSM-脾直径与血小板比值评分（LSPS）和上消化道内镜检查。
结果
15 例（47%）患者有食管静脉曲张（A 组），16 例无静脉曲张（B 组）。A 组的 LSM（kPa）和 LSPS 中位数均显著高于 B 组（LSM：17.0 对 7.5，分别；p=0.0001；LSPS：19.62 对 2.94，分别；p=0.0001）。预测食管静脉曲张的最佳截断值为：LSM＞10.6kPa（敏感性：87%，特异性：87.5%，PPV：87%，NPV：87.5%，AUC：0.92）和 LSPS≥9.2（敏感性：91%，特异性：92%，PPV：91%，NPV：92%，AUC：0.96）。
结论
非侵入性方法可预测胆道闭锁患者是否存在食管静脉曲张；两种非侵入性方法的连续使用可提高准确性。
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