Iwao T, Toyonaga A, Ikegami M, Shigemori H, Oho K, Sumino M, Sakaki M, Nakayama M, Nishiyama T, Minetoma T
Department of Medicine II, Kurume University School of Medicine, Japan.
Gastrointest Endosc. 1994 Jul-Aug;40(4):470-3. doi: 10.1016/s0016-5107(94)70212-8.
To assess the significance of McCormack's gastric mucosal signs for diagnosing portal hypertension, 100 controls and 100 patients with cirrhosis and portal hypertension underwent endoscopy. Each endoscopic recording was reviewed by multiple blinded observers to reduce bias. Individual signs more frequently observed in patients with cirrhosis and portal hypertension than in controls were fine pink speckling (20% versus 8%, p < 0.05), the snakeskin pattern (30% versus 5%, p < 0.01), and cherry-red spots (15% versus 3%, p < 0.01). In contrast, the prevalence of superficial reddening was similar in the two groups (7% versus 13%, NS). Overall, these gastric mucosal signs also appeared more commonly in patients with portal hypertension than in controls (54% versus 27%, p < 0.01); the sensitivity, specificity, and accuracy of McCormack's signs (overall assessment) for diagnosing portal hypertension were 54%, 73%, and 64%, respectively. Corresponding figures for modified McCormack's signs (exclusion of superficial reddening) were 50%, 85%, and 68%. However, these figures were still lower than those for gastroesophageal varices (72%, 100%, and 86%). We conclude that (1) superficial reddening is not a specific finding in patients with portal hypertension, and (2) gastric mucosal findings are of low sensitivity and specificity for diagnosing portal hypertension compared with gastroesophageal varices.
为评估麦科马克胃黏膜征象对诊断门静脉高压的意义，100名对照者和100名肝硬化合并门静脉高压患者接受了内镜检查。每一份内镜记录都由多名不知情的观察者进行复查以减少偏差。肝硬化合并门静脉高压患者比对照者更常观察到的个体征象为细粉色斑点（20%对8%，p<0.05）、蛇皮样改变（30%对5%，p<0.01）和樱桃红点（15%对3%，p<0.01）。相比之下，两组浅表发红的发生率相似（7%对13%，无显著性差异）。总体而言，这些胃黏膜征象在门静脉高压患者中也比对照者更常见（54%对27%，p<0.01）；麦科马克征象（总体评估）诊断门静脉高压的敏感性、特异性和准确性分别为54%、73%和64%。改良麦科马克征象（排除浅表发红）的相应数字为50%、85%和68%。然而，这些数字仍低于食管胃静脉曲张的相应数字（72%、100%和86%）。我们得出结论：（1）浅表发红并非门静脉高压患者的特异性表现；（2）与食管胃静脉曲张相比，胃黏膜表现对门静脉高压的诊断敏感性和特异性较低。
