慢性肝病中通过非侵入性手段筛查食管静脉曲张

Screening of Esophageal Varices by Noninvasive Means in Chronic Liver Disease.

作者信息

Hossain Enayet, Ahammed Ferdaus, K Saha Satyajit, A Foez Syed, A Rahim Mohammad, M Noor-E-Alam Sheikh, S Abdullah Abu

机构信息

Department of Medicine, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh.

Department of Hepatology, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh.

出版信息

Euroasian J Hepatogastroenterol. 2018 Jan-Jun;8(1):18-22. doi: 10.5005/jp-journals-10018-1252. Epub 2018 May 1.

DOI:10.5005/jp-journals-10018-1252

PMID:29963456

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6024039/

Abstract

INTRODUCTION

Noninvasive assessment of esophageal varices (EV) decreases the medical and financial burden related to screening and helps in the management of patients with chronic liver diseases (CLDs). In this study, our aim was to assess the utility of the platelet count/spleen diameter index for the noninvasive evaluation of EV.

MATERIALS AND METHODS

In this cross-sectional observational study, a total of 100 CLD patients underwent screening endoscopy for EV in Medicine and Gastroenterology Department, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh. Platelet count/spleen diameter ratio was assessed in all patients and its diagnostic implication was calculated.

RESULTS

Upper gastrointestinal endoscopy revealed that 45 (45.0%) patients had medium EV followed by 27 (27.0%) that had small EV and 19 (19.0%) patients had large EV. Receiver operator characteristic (ROC) curve was constructed using platelet count/spleen index, which gave a cut-off value of >905. The validity of platelet count/spleen index evaluation of CLD was: Sensitivity 92.3%, specificity 66.7%, accuracy 90.0%, positive predictive value (PPV) and negative predictive value (NPV) were 96.6 and 46.2% respectively. True positive was 84 cases, false positive 3 cases, false negative 7 cases, and true negative 6 cases. If we consider cut-off value as 909 in the evaluation of EV in CLD, then true positive was 85 cases, false positive 3 cases, false negative 6 cases, and true negative 6 cases. From this, by calculation, sensitivity was 93.4%, specificity 66.7%, accuracy 91%, PPV 96.6%, and NPV 50%.

CONCLUSION

The platelet count/spleen index may be proposed to be a safe and reliable mean of screening of EV in CLD patients; however, case-control study would be required to validate this. Hossain E, Ahammed F, Saha SK, Foez SA, Rahim MA, Noor-e-Alam SM, Abdullah AS. Screening of Esophageal Varices by Noninvasive Means in Chronic Liver Disease. Euroasian J Hepato-Gastroenterol 2018;8(1):18-22.

摘要

引言

食管静脉曲张（EV）的无创评估可减轻与筛查相关的医疗和经济负担，并有助于慢性肝病（CLD）患者的管理。在本研究中，我们的目的是评估血小板计数/脾脏直径指数在EV无创评估中的效用。

材料与方法

在这项横断面观察性研究中，孟加拉国锡尔赫特MAG奥斯曼尼医学院医院内科和胃肠病科共有100例CLD患者接受了EV筛查内镜检查。评估所有患者的血小板计数/脾脏直径比值，并计算其诊断意义。

结果

上消化道内镜检查显示，45例（45.0%）患者有中度EV，其次27例（27.0%）有轻度EV，19例（19.0%）患者有重度EV。使用血小板计数/脾脏指数构建受试者操作特征（ROC）曲线，其截断值>905。血小板计数/脾脏指数评估CLD的有效性为：敏感性92.3%，特异性66.7%，准确性90.0%，阳性预测值（PPV）和阴性预测值（NPV）分别为96.6%和46.2%。真阳性84例，假阳性3例，假阴性7例，真阴性6例。如果在CLD患者EV评估中将截断值视为909，那么真阳性85例，假阳性3例，假阴性6例，真阴性6例。由此计算得出，敏感性为93.4%，特异性66.7%，准确性91%，PPV 96.6%，NPV 50%。

结论

血小板计数/脾脏指数可被认为是CLD患者筛查EV的一种安全可靠的方法；然而，需要进行病例对照研究来验证这一点。侯赛因E、艾哈迈德F、萨哈SK、福伊兹SA、拉希姆MA、努尔-伊-阿拉姆SM、阿卜杜拉AS。慢性肝病患者食管静脉曲张的无创筛查。《欧亚肝脏胃肠病学杂志》2018年；8（1）：18 - 22。