加纳一家教学医院中肝硬化患者食管静脉曲张预测指标的非侵入性标志物

Non-invasive markers as predictors of oesophageal varices in cirrhotic patient in a teaching hospital in Ghana.

作者信息

Duah Amoako, Nkrumah Kofi N, Tachi Kenneth

机构信息

Department of Medicine, St. Dominic Hospital, Akwatia, Ghana.

Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Science, University of Ghana.

出版信息

Ghana Med J. 2019 Jun;53(2):142-149. doi: 10.4314/gmj.v53i2.9.

DOI:10.4314/gmj.v53i2.9

PMID:31481810

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6697776/

Abstract

INTRODUCTION

Oesophageal variceal (OV) bleeding is a potentially fatal consequence of portal hypertension in patients with liver cirrhosis. Upper GI endoscopy is recommended for screening for varices in cirrhotics for early detection and treatment, however, this is invasive. The purpose of this study was to assess the predictive values of the noninvasive tests in detecting the presence of OV.

METHODS

A cross-sectional hospital-based study involving 149 patients with liver cirrhosis was carried out at the Korle-Bu Teaching Hospital from 1 November 2015 to 25 November 2016. Relevant clinical parameters assessed included Child-Pugh class, ascites and splenomegaly. Full blood count and liver function tests, abdominal ultrasound and gastroscopy were done for all the participants. Receiver operating characteristic curve was generated to determine the cut-off values for the best sensitivity, specificity, negative and positive predictive values of the variables (serum albumin, platelet count (PC), aspartate aminotransferase (AST)/alanine aminotransferase (ALT), PC/Spleen diameter( SD)) with regard to the presence of OV.

RESULTS

On gastroscopy, 135 (90.60%) had OV and 14 patients (9.40%) had no OV. One hundred and eleven of the varices (82.22%) were large varices and the rest (17.78%) small varices. The overall mean of serum albumin, PC and PC/SD were not significant predictors of the presence of OV. However, the overall mean of AST/ALT significantly predicted the presence of OV. A PC/SD cut off value of ≤833.3 had 72.62% diagnostic accuracy for diagnosing all OV.

CONCLUSION

PC/SD cut-off could be used to screen cirrhotics for OV and treatment initiated in geographical areas lacking endoscopy facilities.

FUNDING

None declared.

摘要

引言

食管静脉曲张（OV）出血是肝硬化患者门静脉高压的潜在致命后果。建议对上消化道进行内镜检查以筛查肝硬化患者的静脉曲张，以便早期发现和治疗，然而，这是一种侵入性检查。本研究的目的是评估非侵入性检查在检测OV存在方面的预测价值。

方法

2015年11月1日至2016年11月25日，在科勒-布教学医院对149例肝硬化患者进行了一项基于医院的横断面研究。评估的相关临床参数包括Child-Pugh分级、腹水和脾肿大。对所有参与者进行了全血细胞计数和肝功能检查、腹部超声检查和胃镜检查。生成受试者工作特征曲线以确定变量（血清白蛋白、血小板计数（PC）、天冬氨酸转氨酶（AST）/丙氨酸转氨酶（ALT）、PC/脾脏直径（SD））关于OV存在的最佳敏感性、特异性、阴性和阳性预测值的临界值。

结果

胃镜检查显示，135例（90.60%）有OV，14例（9.40%）无OV。其中111例静脉曲张（82.22%）为大静脉曲张，其余（17.78%）为小静脉曲张。血清白蛋白、PC和PC/SD的总体平均值不是OV存在的显著预测指标。然而，AST/ALT的总体平均值显著预测了OV的存在。PC/SD临界值≤833.3对所有OV的诊断准确率为72.62%。