Amer Ibrahim F, El Shennawy Eslam M, El Batea Hassan, Ahmed Mohammed Hussien, El Sharawy Shimaa, Mahros Aya M
Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine Kafrelsheikh University Kafr el-Sheikh Egypt.
Tropical Medicine Department, Faculty of Medicine Tanta University Tanta Egypt.
JGH Open. 2021 Jan 18;5(2):286-293. doi: 10.1002/jgh3.12486. eCollection 2021 Feb.
Liver cirrhosis (LC) is commonly associated with portal hypertensive gastropathy (PHG), and it causes gastrointestinal (GI) bleeding. Esophagogastroduodenoscopy (EGD) is the gold standard in diagnosing PHG. Besides its invasiveness, the disadvantages of EGD include psychological and financial problems. We aimed to evaluate the diagnostic accuracy of different noninvasive screening tools in predicting PHG.
This cross-sectional study was conducted on 100 patients with LC who were divided into two groups based on EGD: group (A), 50 patients with LC with PHG, and group (B), 50 patients with LC without PHG. All patients were subjected to history taking, full clinical examination, laboratory investigations, abdominal-pelvic ultrasonography, and EGD.
To predict PHG, the respective sensitivity and specificity of portal vein diameter (>10.5 mm) were 86 and 67%, of gallbladder wall thickness (GBWT) (>3.5 mm) were 64 and 68%, of platelets/GBWT (<40) were 68 and 78%, of aspartate aminotransferase (AST)/platelet ratio index (APRI) score (>1.1) were 60 and 66%, of platelet/spleen diameter (<1290) were 88 and 72%, of right liver lobe diameter/albumin ratio (>4) were 74 and 80%, and of AST/alanine aminotransferase (ALT) ratio (>1.1) were 50 and 58% ( = 0.353).
Portal vein diameter, platelet/spleen diameter, and right liver lobe diameter/albumin ratio were independently associated with PHG and were good predictors of the PHG, whereas AST/ALT ratio and King score are poor predictors.
肝硬化（LC）常与门静脉高压性胃病（PHG）相关，可导致胃肠道（GI）出血。食管胃十二指肠镜检查（EGD）是诊断PHG的金标准。除了具有侵入性外，EGD的缺点还包括心理和经济问题。我们旨在评估不同无创筛查工具预测PHG的诊断准确性。
本横断面研究对100例LC患者进行，根据EGD结果将其分为两组：A组，50例合并PHG的LC患者；B组，50例不合并PHG的LC患者。所有患者均接受病史采集、全面临床检查、实验室检查、腹部盆腔超声检查及EGD检查。
为预测PHG，门静脉直径（>10.5mm）的敏感性和特异性分别为86%和67%，胆囊壁厚度（GBWT）（>3.5mm）的敏感性和特异性分别为64%和68%，血小板/GBWT（<40）的敏感性和特异性分别为68%和78%，天冬氨酸转氨酶（AST）/血小板比率指数（APRI）评分（>1.1）的敏感性和特异性分别为60%和66%，血小板/脾直径（<1290）的敏感性和特异性分别为88%和72%，右肝叶直径/白蛋白比率（>4）的敏感性和特异性分别为74%和80%，AST/丙氨酸转氨酶（ALT）比率（>1.1）的敏感性和特异性分别为50%和58%（P = 0.353）。
门静脉直径、血小板/脾直径及右肝叶直径/白蛋白比率与PHG独立相关，是PHG的良好预测指标，而AST/ALT比率和金氏评分是较差的预测指标。
