Arribas Anta J, García González M, Torres Guerrero M E, Garrido Gómez E, Rodríguez de Santiago E, López Durán S, Zaera de la Fuente C, Benita León V, Mesonero Gismero F, Martín de Argila C, Albillos Martínez A
Hospital U. Ramón y Cajal, Carretera Colmenar Viejo km 9,1, Madrid, España.
Acta Gastroenterol Belg. 2018 Oct-Dec;81(4):496-501.
Upper gastrointestinal endoscopy (UGE) is currently recommended in cirrhotic patients to detect the presence of esophageal varices (EV). Spleen stiffness measurement (SSM) with FibroScan has been used for this purpose, showing variable sensitivity (S) and specificity (Sp). The aim of this study was to evaluate the capability of SSM to detect the presence and size of EV in cirrhotic patients in comparison to other noninvasive modalities.
Sixty-six patients with cirrhosis who had undergone UGE in the previous 6 months underwent SSM and liver stiffness measurement (LSM) using FibroScan. Biochemical parameters and ultrasonography data were also collected to calculate other noninvasive indexes.
Valid spleen stiffness measurements were obtained for 60 of the 66 patients initially included in the study (90.1%). In the multivariate analysis only splenomegaly and SSM were predictive of esophageal varices. SSM was the most accurate diagnostic tool, obtaining an area under the ROC curve of 0.8 for values below 48 KPascals, with S = 87%, Sp = 69%, and 76.7% of successfully diagnosed patients.
SSM with FibroScan was significantly higher for cirrhotic patients with EV. Our study suggests that spleen stiffness may be useful to identify cirrhotic patients at risk of having EV, although further studies are needed.
目前推荐对肝硬化患者进行上消化道内镜检查（UGE）以检测食管静脉曲张（EV）的存在。已使用FibroScan进行脾脏硬度测量（SSM）来达到此目的，其敏感性（S）和特异性（Sp）各不相同。本研究的目的是与其他非侵入性方法相比，评估SSM检测肝硬化患者中EV的存在及大小的能力。
66例在过去6个月内接受过UGE的肝硬化患者使用FibroScan进行了SSM和肝脏硬度测量（LSM）。还收集了生化参数和超声检查数据以计算其他非侵入性指标。
最初纳入研究的66例患者中有60例获得了有效的脾脏硬度测量结果（90.1%）。在多变量分析中，只有脾肿大和SSM可预测食管静脉曲张。SSM是最准确的诊断工具，对于低于48千帕斯卡的值，ROC曲线下面积为0.8，敏感性为87%，特异性为69%，成功诊断的患者比例为76.7%。
对于患有EV的肝硬化患者，使用FibroScan进行SSM的结果显著更高。我们的研究表明，脾脏硬度可能有助于识别有EV风险的肝硬化患者，尽管还需要进一步研究。
