Torres E, Barros P, Calmet F
Department of Internal Medicine, Universidad Peruana Cayetano Heredia, School of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru.
Am J Gastroenterol. 1998 Nov;93(11):2172-8. doi: 10.1111/j.1572-0241.1998.00615.x.
We sought to determine the correlation between the level of serum-ascites albumin concentration gradient (SAAG) and the complications of portal hypertension (PHTN), manifested by the presence and grade of esophageal varices (EV).
Our study included 31 patients with ascites, demonstrated by ultrasonography, who had measurement of the SAAG. All had upper gastrointestinal endoscopy with assessment of the presence and size of EV. High SAAG was considered to be present when the SAAG was > or = 1.1 g/dl and Low SAAG when it measured < 1.1 g/dl.
We found that 25 of 31 (80.6%) patients had High SAAG and six of 31 (19.4%) had Low SAAG. Esophageal varices were present in 17 of 25 (68%) patients with High SAAG and in none of six (0%) patients with Low SAAG (p = 0.028). In patients with alcoholic liver disease (ALD), 14 of 14 (100%) had EV. Otherwise, in patients with nonALD, only three of 11 (27.3%) had EV (p < 0.05). The presence of EV was associated with the Child-Pugh Score (p = 0.039). Among patients with High SAAG, EV were present in four of 10 (40%) with SAAG values of 1.10-1.49 g/dl; in four of 6 (66.7%) with SAAG values of 1.50-1.99 g/dl; and in nine of nine (100%) with SAAG values of > or =2.0 g/dl (p = 0.049). The size of the EV had no association with the level of SAAG in patients with High SAAG (p = 0.788), with a Pearson correlation coefficient of R = 0.54 (p = 0.005). Using the Receiver-Operating-Characteristic Curve a SAAG value of > or =1.435 +/- 0.015 g/dl was an accurate indicator of the presence of EV (cutoff point for the higher predictive value: positive = 87.5% and negative = 66.7%).
In patients with ascites the presence of EV is associated only with patients with High SAAG. The presence of EV in patients with ascites and High SAAG is directly related to the degree of SAAG. The size of the EV in patients with ascites and High SAAG is not associated with the degree of SAAG. A SAAG value of > or =1.435 +/- 0.015 g/dl is a useful means to predict the presence of EV in patients with ascites. Finally, in patients with ascites, EV were more prevalent in those with ALD.
我们试图确定血清腹水白蛋白浓度梯度（SAAG）水平与以食管静脉曲张（EV）的存在及分级为表现的门静脉高压（PHTN）并发症之间的相关性。
我们的研究纳入了31例经超声检查证实有腹水的患者，这些患者均测量了SAAG。所有患者均接受了上消化道内镜检查，以评估EV的存在及大小。当SAAG≥1.1 g/dl时认为存在高SAAG，当测量值＜1.1 g/dl时为低SAAG。
我们发现31例患者中有25例（80.6%）为高SAAG，31例中有6例（19.4%）为低SAAG。25例高SAAG患者中有17例（68%）存在食管静脉曲张，而6例低SAAG患者中无一例（0%）存在食管静脉曲张（p = 0.028）。在酒精性肝病（ALD）患者中，14例（100%）有食管静脉曲张。否则，在非ALD患者中，11例中只有3例（27.3%）有食管静脉曲张（p＜0.05）。食管静脉曲张的存在与Child-Pugh评分相关（p = 0.039）。在高SAAG患者中，SAAG值为1.10 - 1.49 g/dl的10例中有4例（40%）存在食管静脉曲张；SAAG值为1.50 - 1.99 g/dl的6例中有4例（66.7%）；SAAG值≥2.0 g/dl的9例中有9例（100%）（p = 0.049）。高SAAG患者中食管静脉曲张的大小与SAAG水平无关（p = 0.788），Pearson相关系数R = 0.54（p = 0.005）。使用受试者工作特征曲线，SAAG值≥1.435±0.015 g/dl是食管静脉曲张存在的准确指标（预测价值较高的截断点：阳性率 = 87.5%，阴性率 = 66.7%）。
在腹水患者中，食管静脉曲张的存在仅与高SAAG患者相关。腹水且高SAAG患者中食管静脉曲张的存在与SAAG程度直接相关。腹水且高SAAG患者中食管静脉曲张的大小与SAAG程度无关。SAAG值≥1.435±0.015 g/dl是预测腹水患者食管静脉曲张存在的有用方法。最后，在腹水患者中，食管静脉曲张在ALD患者中更常见。
