血小板计数与脾脏直径比值：一种预测肝硬化患者食管静脉曲张的有前景的非侵入性工具。
Platelet counts to spleen diameter ratio: A promising noninvasive tool for predicting esophageal varices in cirrhosis patients.
作者信息
Mossie Getnet Yigzaw, Nur Abdulsemed Mohammed, Ayalew Zekarias Seifu, Azibte Gebeyehu Tessema, Berhane Kaleb Assefa
机构信息
Department of Internal Medicine, Addis Ababa University, Addis Ababa 1000, Ethiopia.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 1000, Ethiopia.
出版信息
World J Hepatol. 2024 Oct 27;16(10):1177-1187. doi: 10.4254/wjh.v16.i10.1177.
BACKGROUND
Liver cirrhosis is the end stage of progressive liver fibrosis as a consequence of chronic liver inflammation, wherein the standard hepatic architecture is replaced by regenerative hepatic nodules, which eventually lead to liver failure. Cirrhosis without any symptoms is referred to as compensated cirrhosis. Complications such as ascites, variceal bleeding, and hepatic encephalopathy indicate the onset of decompensated cirrhosis. Gastroesophageal varices are the hallmark of clinically significant portal hypertension.
AIM
To determine the accuracy of the platelet count-to-spleen diameter (PC/SD) ratio to evaluate esophageal varices (EV) in patients with cirrhosis.
METHODS
This retrospective observational study was conducted at Tikur Anbessa Specialized Hospital and Adera Medical Center from January 1, 2019, to December 30, 2023. Data were collected chart review and direct patient interviews using structured questionnaires. The data were exported to the SPSS software version 26 for analysis and clearance. A receiver operating characteristic curve was plotted for splenic diameter, platelet count, and PC/SD ratio to obtain sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio.
RESULTS
Of the 140 participants, 67% were men. Hepatitis B (38%) was the most common cause of cirrhosis, followed by cryptogenic cirrhosis (28%) and hepatitis C (16%). Approximately 83.6% of the participants had endoscopic evidence of EV, whereas 51.1% had gastric varices. Decompensated cirrhosis and PC were associated with the presence of EV with adjusted odds ratios of 12.63 (95%CI: 3.16-67.58, = 0.001) and 0.14 (95%CI: 0.037-0.52, = 0.004), respectively. A PC/SD ratio < 1119 had a sensitivity of 86.32% and specificity of 70% with area under the curve of 0.835 (95%CI: 0.736-0.934, < 0.001).
CONCLUSION
A PC/SD ratio < 1119 predicts EV in patients with cirrhosis. It is a valuable, noninvasive tool for EV risk assessment in resource-limited settings.
背景
肝硬化是慢性肝脏炎症导致的进行性肝纤维化的终末期，其中标准的肝结构被再生性肝结节取代，最终导致肝功能衰竭。没有任何症状的肝硬化被称为代偿期肝硬化。腹水、静脉曲张出血和肝性脑病等并发症表明失代偿期肝硬化的开始。胃食管静脉曲张是临床上显著门静脉高压的标志。
目的
确定血小板计数与脾直径（PC/SD）比值评估肝硬化患者食管静脉曲张（EV）的准确性。
方法
这项回顾性观察性研究于2019年1月1日至2023年12月30日在提库尔·安贝萨专科医院和阿德拉医疗中心进行。通过病历审查和使用结构化问卷对患者进行直接访谈收集数据。将数据导出到SPSS 26版软件进行分析和清理。绘制脾直径、血小板计数和PC/SD比值的受试者工作特征曲线，以获得敏感性、特异性、阳性预测值、阴性预测值、阳性似然比和阴性似然比。
结果
140名参与者中，67%为男性。乙型肝炎（38%）是肝硬化最常见的原因，其次是隐源性肝硬化（28%）和丙型肝炎（16%）。约83.6%的参与者有内镜下EV证据，而51.1%有胃静脉曲张。失代偿期肝硬化和血小板计数与EV的存在相关，调整后的比值比分别为12.63（95%CI：3.16 - 67.58，P = 0.001）和0.14（95%CI：0.037 - 0.52，P = 0.004）。PC/SD比值<1119时，敏感性为86.32%，特异性为70%，曲线下面积为0.835（95%CI：0.736 - 0.934，P<0.001）。
结论
PC/SD比值<1119可预测肝硬化患者的EV。它是资源有限环境中评估EV风险的一种有价值的非侵入性工具。
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