Galal Ghada M, Amin Nabila F, Abdel Hafeez Heba A, El-Baz Mona A H
Department of Tropical Medicine, and Gastroenterology, Sohag Faculty of Medicine, Sohag University, Egypt.
Arab J Gastroenterol. 2011 Jun;12(2):62-7. doi: 10.1016/j.ajg.2011.04.003. Epub 2011 May 31.
Non-invasive predictors of medium/large oesophageal varices (LOVs) could reduce the number of screening endoscopies. As portal hypertension is a consequence of liver fibrosis, serum fibrosis markers were evaluated together with other variables as possible non-invasive predictors of medium OV/LOV.
A total of 154 cirrhotic patients with splenomegaly and 30 healthy control subjects were recruited in a prospective study in two gastroenterology centres in Upper Egypt. Clinical parameters assessed included Child-Pugh class, liver size and ascites. Laboratory parameters included complete blood count, liver function tests, and aspartate aminotransferase (AST)/platelet ratio. Transforming growth factor-β(1) (TGF-β(1)), alpha(2) macroglobulin (A(2)M) and hyaluronic acid (HA) were assayed. Ultrasonographic examination was done for assessment of liver span, portal vein diameter and detection of minimal ascites. Oesophageal varices were diagnosed and graded by oesophagogastroduodenoscopy.
Fifty-four patients (35%) had no or small varices and 100 (65%) patients had medium OV/LOV by endoscopy. On multivariate analysis, the independent predictors of medium OV/LOV were the presence of ascites (β=0.258, p=0.047) and serum HA (β=0.449, p=0.009). The receiver operating characteristic curve for HA showed the area under the curve to be 0.916. The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of HA at a cut-off value of 207μgl(-1) were 94%, 77.8%, 88.7%, 87.5% and 88.3%, respectively.
The presence of ascites and serum HA level higher than 207μgl(-1) can predict the presence of medium OV/LOV in cirrhotic patients. This would help physicians to identify patients who would most likely benefit from screening endoscopy and thus, reduce costs and discomfort from unnecessary endoscopic procedures.
中/大型食管静脉曲张（LOV）的非侵入性预测指标可减少筛查性内镜检查的次数。由于门静脉高压是肝纤维化的结果，因此对血清纤维化标志物以及其他变量进行评估，以作为中重度食管静脉曲张（OV）/LOV可能的非侵入性预测指标。
在埃及上埃及地区的两个胃肠病中心进行的一项前瞻性研究中，共招募了154例有脾肿大的肝硬化患者和30例健康对照者。评估的临床参数包括Child-Pugh分级、肝脏大小和腹水情况。实验室参数包括全血细胞计数、肝功能检查以及天冬氨酸转氨酶（AST）/血小板比值。检测了转化生长因子-β(1)（TGF-β(1)）、α(2)巨球蛋白（A(2)M）和透明质酸（HA）。进行超声检查以评估肝左右径、门静脉直径并检测微量腹水。通过食管胃十二指肠镜检查诊断并分级食管静脉曲张。
54例患者（35%）无或有小静脉曲张，100例患者（65%）经内镜检查发现有中重度OV/LOV。多因素分析显示，中重度OV/LOV的独立预测指标为腹水的存在（β=0.258，p=0.047）和血清HA（β=0.449，p=0.009）。HA的受试者工作特征曲线显示曲线下面积为0.916。当HA临界值为207μg/L(-1)时，其敏感性、特异性、阳性和阴性预测值以及诊断准确性分别为94%、77.8%、88.7%、87.5%和88.3%。
腹水的存在以及血清HA水平高于207μg/L(-1)可预测肝硬化患者中重度OV/LOV的存在。这将有助于医生识别最可能从筛查性内镜检查中获益的患者，从而降低不必要内镜检查的成本和不适。
