Qi Hong, Yang Xuan, Yan Man, Wang Yange, Fang Xueqin, Sun Li
Department of Infection, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University Xi'an 710018, Shaanxi, China.
Department of Hepatobiliary, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University Xi'an 710018, Shaanxi, China.
Am J Transl Res. 2024 Aug 15;16(8):3769-3777. doi: 10.62347/XQUE3108. eCollection 2024.
To evaluate the predictive efficacy of the platelets-to-spleen diameter ratio (PSDR) for developing esophagogastric varices (EV) in patients with cirrhosis due to hepatitis B virus (HBV).
We conducted a retrospective cohort study using data from patients treated for HBV induced cirrhosis at Xi'an No. 3 Hospital, the Affiliated Hospital of Northwest University, from June 2020 to August 2023. Patients were categorized into two groups based on endoscopic evidence of EV: an EV group and a non-EV group. Clinical, sonographic, and hematological findings were compared within and between these groups. Stratified analyses based on the severity of varices were performed, and multivariate logistic regression was used to identify predictors of EV. Receiver Operating Characteristic (ROC) curve analysis assessed the diagnostic accuracy of PSDR in predicting EV.
The study included 139 patients diagnosed with HBV induced cirrhosis, divided into an EV group (86 patients, with 48 low-risk and 38 high-risk) and a non-EV group (53 patients). Significant differences were found between the groups in several parameters: Child-Pugh classification, Child-Pugh score, portal vein diameter, hepatic vein deceleration index, spleen thickness, and PSDR (all P<0.001). These variables also varied significantly across the different risk categories within the EV group (all P<0.001). Multivariate logistic regression indicated PSDR as an independent predictor of EV development (Odds Ratio [OR]=3.569, 95% Confidence Interval [CI]: 0.970-1.001, P<0.001). ROC curve analysis showed that PSDR had an Area Under the Curve (AUC) of 0.865 (95% CI: 0.764-0.965) for predicting EV, with an optimal threshold of 1013.2, achieving 88.46% sensitivity and 69.23% specificity. For high-risk EV, PSDR showed an AUC of 0.763 (95% CI: 0.670-0.856), with a threshold of 883.5, sensitivity of 79.17%, and specificity of 54.17%.
The PSDR is a significant risk marker and demonstrates strong predictive utility for both the presence and severity of EV in patients with HBV-induced cirrhosis. PSDR provides a valuable, non-invasive diagnostic tool for anticipating the development of EV in this patient population.
评估血小板与脾脏直径比值（PSDR）对乙型肝炎病毒（HBV）所致肝硬化患者发生食管胃静脉曲张（EV）的预测效能。
我们进行了一项回顾性队列研究，使用了2020年6月至2023年8月在西北大学附属西安第三医院接受HBV所致肝硬化治疗的患者数据。根据内镜检查EV的证据将患者分为两组：EV组和非EV组。比较这些组内和组间的临床、超声和血液学检查结果。基于静脉曲张严重程度进行分层分析，并使用多因素逻辑回归来确定EV的预测因素。采用受试者操作特征（ROC）曲线分析评估PSDR预测EV的诊断准确性。
该研究纳入了139例诊断为HBV所致肝硬化的患者，分为EV组（86例，其中48例低风险和38例高风险）和非EV组（53例）。两组在几个参数上存在显著差异：Child-Pugh分级、Child-Pugh评分、门静脉直径、肝静脉减速指数、脾脏厚度和PSDR（均P<0.001）。这些变量在EV组内不同风险类别之间也有显著差异（均P<0.001）。多因素逻辑回归表明PSDR是EV发生的独立预测因素（比值比[OR]=3.569，95%置信区间[CI]：0.970 - 1.001，P<0.001）。ROC曲线分析显示，PSDR预测EV的曲线下面积（AUC）为0.865（95%CI：0.764 - 0.965），最佳阈值为1013.2，灵敏度为88.46%，特异度为69.23%。对于高风险EV，PSDR的AUC为0.763（95%CI：0.670 - 0.856），阈值为883.5，灵敏度为79.17%，特异度为54.17%。
PSDR是一个重要的风险标志物，对HBV所致肝硬化患者EV的存在和严重程度均具有强大的预测效用。PSDR为预测该患者群体中EV的发生提供了一种有价值的非侵入性诊断工具。
