Chiodi Daniela, Hernández Nelia, Saona Gustavo, Sánchez Adriana, Berrueta Joaquín, Mescia Germán, Pollio Carmen, Robaina Gabriela
Acta Gastroenterol Latinoam. 2014 Jun;44(2):108-13.
Variceal bleeding is a frequent and serious complication of cirrhosis. Early detection of varices by videogastroscope (VGC) is recommended in all patients with cirrhosis to determine the need for prophylactic treatment. Have been described noninvasive markers of the presence of esophageal varices, which could prevent the realization of VGC for that purpose.
To determine and compare noninvasive (longitudinal diameter of spleen, platelet count, platelet reason / spleen) as predictors of the presence of esophageal varices.
We retrospectively studied 125 patients with cirrhosis from any cause. They had VGC, blood count and abdominal ultrasonography. The diagnostic accuracy for determining the presence of esophageal varices or large varices according to the different variables was studied using the area under the ROC curve (AUROC).
The prevalence of esophageal varices was 63.2% and 42.4% were diagnosed with large varices. The reason platelets/spleen and platelet count showed an AUROC of 0.74 for the detection of esophageal varices. The cut-off for the ratio platelets / spleen was 1.010 (sensitivity 72.15% and specificity 71.74%) for the presence of varices and 870 for the presence of clinically significant varices (sensitivity 62.26% and specificity 62.50%). The analysis according to these breakpoints showed that 23.6% of patients with scores higher than 1,010 had large varices and 45% of patients with values lower than 870 had not large varices.
Although the reason platelets/spleen showed an AUROC acceptable, its implementation would entail a risk of not diagnosing large varices in almost a quarter of the population studied.
静脉曲张破裂出血是肝硬化常见且严重的并发症。建议对所有肝硬化患者进行电子胃镜（VGC）检查以早期发现静脉曲张，从而确定是否需要进行预防性治疗。已有研究描述了食管静脉曲张存在的非侵入性标志物，可避免为此目的进行电子胃镜检查。
确定并比较非侵入性指标（脾脏纵径、血小板计数、血小板/脾脏比值）作为食管静脉曲张存在的预测指标。
我们回顾性研究了125例各种病因导致的肝硬化患者。他们均接受了电子胃镜检查、血常规检查和腹部超声检查。使用ROC曲线下面积（AUROC）研究根据不同变量确定食管静脉曲张或大静脉曲张存在的诊断准确性。
食管静脉曲张的患病率为63.2%，42.4%被诊断为大静脉曲张。血小板/脾脏比值和血小板计数检测食管静脉曲张的AUROC为0.74。静脉曲张存在时血小板/脾脏比值的截断值为1.010（敏感性72.15%，特异性71.74%），临床显著静脉曲张存在时为870（敏感性62.26%，特异性62.50%）。根据这些断点进行分析显示，比值高于1.010的患者中有23.6%患有大静脉曲张，低于870的患者中有45%没有大静脉曲张。
尽管血小板/脾脏比值显示出可接受的AUROC，但应用该指标在近四分之一的研究人群中存在漏诊大静脉曲张的风险。
