Department of Gastroenterology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, 260-8670, Japan.
Clin Transl Gastroenterol. 2018 May 25;9(5):154. doi: 10.1038/s41424-018-0021-8.
To examine the effect of hemodynamic assessment of the left gastric vein (LGV) as a noninvasive test to diagnose esophageal varices (EV) in cirrhosis patients.
This cross-sectional study consisted of 229 cirrhosis patients (62.7 ± 11.8 years; Child-Pugh score 5-14). One hundred fifty-four patients had EV (67.2%; small, 53; medium, 71; large, 30). All patients underwent a blood test and Doppler ultrasound followed by upper gastrointestinal endoscopy on the same day. The diagnostic ability for EV was compared between LGV-related findings and the platelet count/spleen diameter ratio (Plt/Spl).
The detectability of the LGV was higher in patients with EV (129/144, 89.6%) than in those without (35/75, 46.7%; p < 0.0001), and was higher in those with large EV (30/30, 100%) than in those without (134/199, 67.3%; p = 0.0002). The positive detection of the LGV showed 100% sensitivity and negative predictive value (NPV) to identify large EV in the whole cohort and compensated group (n = 127). The best cutoff value in the LGV diameter was 5.35 mm to identify large EV, showing 0.753 area under the receiver operating characteristic curve (AUROC) with 90% sensitivity and 96.5% NPV. The Plt/Spl showed 62.1% sensitivity and 87.1% NPV, and the best cutoff value was 442.9 to identify large EV with 0.658 AUROC, which was comparable to LGV-based assessment (p = 0.162).
This same-day comparison study demonstrated the value of LGV-based noninvasive test to identify large EV with high sensitivity and NPV in cirrhosis patients at a lower cost.
研究胃左静脉（LGV）血流动力学评估作为一种非侵入性检测方法，用于诊断肝硬化患者食管静脉曲张（EV）的效果。
这是一项横断面研究，共纳入 229 例肝硬化患者（62.7±11.8 岁；Child-Pugh 评分 5-14 分）。其中 154 例患者存在 EV（67.2%；小 53 例，中 71 例，大 30 例）。所有患者均在同一天进行血液检查和多普勒超声检查，随后进行上消化道内镜检查。比较 LGV 相关指标与血小板计数/脾直径比（Plt/Spl）对 EV 的诊断能力。
EV 患者 LGV 的检出率（129/144，89.6%）高于无 EV 患者（35/75，46.7%；p<0.0001），且 LGV 直径较大的患者（30/30，100%）高于 LGV 直径较小的患者（134/199，67.3%；p=0.0002）。在整个队列和代偿组（n=127）中，LGV 阳性检测对大 EV 的诊断具有 100%的敏感性和阴性预测值（NPV）。LGV 直径的最佳截断值为 5.35mm 时，对大 EV 的诊断具有 0.753 的受试者工作特征曲线下面积（AUROC），灵敏度为 90%，NPV 为 96.5%。Plt/Spl 的灵敏度为 62.1%，NPV 为 87.1%，最佳截断值为 442.9 时，对大 EV 的诊断具有 0.658 的 AUROC，与 LGV 为基础的评估相当（p=0.162）。
本同日比较研究表明，LGV 为基础的非侵入性检测在肝硬化患者中具有较高的敏感性和 NPV，可用于诊断大 EV，成本更低。
