肝炎肝硬化患者并发食管胃底静脉曲张破裂出血的预测指标研究

发布时间：2018-04-04 23:15

  本文选题：肝炎　切入点：肝硬化　出处：《中国全科医学》2015年22期

【摘要】：目的了解血清腹腔积液清蛋白梯度(SAAG)、门静脉内径(PVD)及血小板计数与脾长径比值(Plt/S-D)联合应用对肝炎肝硬化患者并发食管胃底静脉曲张破裂出血的预测价值。方法抽取2013年1—12月,在潍坊医学院附属潍坊市人民医院接受住院治疗的肝炎肝硬化患者50例。根据有无食管胃底静脉曲张破裂出血,将其分为出血组(n=26)和非出血组(n=24)。比较并分析两组SAAG、PVD及Plt/S-D,绘制SAAG、PVD、Plt/S-D及三者联合应用对肝炎肝硬化患者并发食管胃底静脉曲张破裂出血预测的受试者工作特征(ROC)曲线。结果 (1)两组SAAG、PVD及Plt/S-D比较,差异有统计学意义(P0.01);非条件Logistic回归分析显示,SAAG、PVD及Plt/S-D对肝炎肝硬化患者并发食管胃底静脉曲张破裂出血的影响有统计学意义(P0.05)。(2)SAAG、PVD、Plt/S-D对肝炎肝硬化患者并发食管胃底静脉曲张破裂出血预测的ROC曲线下面积分别为0.74、0.81及0.67。SAAG取值为20.50 g/L时,灵敏度为80.8%,特异度为58.3%;取值为20.10 g/L时,灵敏度为65.4%,特异度为62.5%。PVD取值为13.50 mm时,灵敏度为80.8%,特异度为66.3%;取值为14.25 mm时,灵敏度为65.4%,特异度为83.3%。Plt/S-D取值为0.88×109个/mm时,灵敏度为80.8%,特异度为66.7%;取值为0.97×109个/mm时,灵敏度为65.4%,特异度为66.7%。(3)SAAG、PVD及Plt/S-D联合应用对肝炎肝硬化患者并发食管胃底静脉曲张破裂出血预测的评分公式为:预测出血评分=SAAG×PVD÷Plt/S-D,ROC曲线下面积为0.91,取值为890.35时有最佳的灵敏度和特异度,分别为87.8%和90.7%。结论 SAAG、PVD及Plt/S-D是肝炎肝硬化患者并发食管胃底静脉曲张破裂出血的影响因素,三项联合应用对肝炎肝硬化患者并发食管胃底静脉曲张破裂出血的预测价值较高。
[Abstract]:Objective to investigate the predictive value of serum albumin gradients in peritoneal effusion, PVD (PVD) and platelet count / spleen length ratio (PLT / S-D) in patients with hepatitis cirrhosis complicated with esophageal and gastric variceal variceal bleeding.Methods from January to December 2013, 50 patients with liver cirrhosis received inpatient treatment in Weifang people's Hospital affiliated to Weifang Medical College.According to the bleeding of esophageal and gastric varices, the patients were divided into two groups: the bleeding group (n = 26) and the non-bleeding group (n = 24).To compare and analyze the two groups of PVD and PltP / S-D of SAAGN PVD and their combined application to predict the bleeding of esophageal varices and fundus varices in patients with hepatitis cirrhosis, and to draw the ROCcurves of the subjects who were used together to predict the bleeding of esophageal varices and fundus fundus varices in patients with hepatitis cirrhosis.Results 1) PVD and Plt/S-D were compared between the two groups.The results of non-conditional Logistic regression analysis showed that there was significant difference in the effect of PVD and Plt/S-D on the bleeding of esophageal and gastric varices in patients with hepatitis and cirrhosis.When the area under the ROC curve was 0.74 卤0.81 and the 0.67.SAAG value was 20.50 g / L, the predicted area under the ROC curve of varicose rupture bleeding was 0.74% and 20.50 g / L, respectively.鐏垫晱搴︿负80.8%,鐗瑰紓搴︿负58.3%;鍙栧，

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