Predictive value of non-invasive parameter for the degree of esophageal varices in patients with post-hepatitis B cirrhosis
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摘要:
目的 探讨瞬时弹性成像技术联合血清学指标、肝脏超声检查对食管静脉曲张程度的预测价值,并建立能够预测食管胃底静脉曲张程度的模型。 方法 按胃镜检查结果,将110例乙肝肝硬化失代偿期患者按食管胃底静脉曲张程度分为:无或轻度组,中或重度组。对肝脏硬度值、血小板计数、凝血时间、血清白蛋白水平、脾脏厚度、门静脉直径、肝脏直径进行单因素分析和logistic回归分析,筛选出可以有效预测食管静脉曲张及程度的无创指标,并在此基础上构建预测模型。应用受试者工作特征曲线分析方法评价模型的诊断价值。 结果 建立预测食管静脉曲张程度的回归方程:y=1.07×肝脏硬度值-0.057×血小板计数+0.783×凝血时间+1.876×门脉直径-0.06×脾脏厚度-40.248,ROC曲线下面积为0.979,诊断敏感性为98.7%,特异度为97.1%。 结论 瞬时弹性成像技术检测肝脏硬度值联合血小板计数、凝血时间、门静脉宽度、脾脏厚度等指标建立的无创预测模型预测食管静脉曲张准确、敏感,具有一定的临床应用价值。 Abstract:Objective To analysis the predictive value of transient elastography combined with serum index and liver ultrasound examination for the degree of esophageal varices (EV), and to establish a predictive model for EV. Methods A total of 110 patients with post-hepatitis B cirrhosis were enrolled and divided into two groups according to EV grade assessed by gastroscope: non-EV and grade I group and grade II and III group. The parameters, including liver stiffness (LS), platelet count (PLT), prothrombin time (PT), serum albumin level, the thickness of spleen, the portal vein diameter and the liver diameter were assessed by independent sample T test and binary logistic regression analysis, based on which a predictive model was generated. The receiver operating characteristic(ROC) curve was used to evaluate the accuracy of the model. Results The area under the ROC curve for the model was 0.979. The sensitivity of the model was 98.7% and the specificity was 97.1%. Conclusion The non-invasive model for predicting EV composed of LS and other non-invasive parameters was accurate and sensitive, thus an ideal model for EV prediction in clinic. -
Key words:
- decompensated liver cirrhosis /
- esophageal varices /
- transient elastography /
- non-invasive /
- diagnosis
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表 1 两组食管静脉曲张患者指标与单因素分析结果(Mean±SD)
变量 例数 肝脏硬度(kPa) 血小板计数(×109/L) 凝血酶原时间(s) 门脉直径(mm) 脾脏厚度(mm) 脾脏直径(mm) 白蛋白(g/L) 轻或无 35 8.94±1.12 147.59±54.39 16.33±2.88 10.42±1.27 5.87±8.68 122.86±17.94 32.25±5.26 中-重度 75 25.08±18.83 89.63±68.05 19.30±2.97 12.64±1.84 51.13±12.31 161.76±15.06 31.77±4.93 t –5.055 4.420 –4.912 –6.469 –2.276 –11.861 P <0.01 <0.01 <0.01 <0.01 0.025 <0.01 0.645 表 2 Logistic多因素分析结果
统计量 肝脏硬度(kPa) 血小板计数(×109/L) 凝血酶原时间(s) 门静脉直径(mm) 脾脏厚度(mm) 常数 回归系数 1.07 –0.057 0.783 1.876 –0.006 –40.248 标准误 0.38 0.023 0.361 0.805 0.041 15.917 Wald 7.945 6.123 4.712 5.428 0.02 6.394 P 0.005 0.013 0.03 0.02 0.887 0.011 OR 2.916 0.945 2.188 6.528 0.994 0 -
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