论文部分内容阅读
目的:探讨乙肝肝硬化患者食管静脉曲张的无创性预测指标。方法:选择2007年1月—2012年1月本院收治的乙肝肝硬化206例,以患者一般特点、临床表现、生化指标和超声结果等为研究参数,根据胃镜检查结果将患者分为无静脉曲张组、所有静脉曲张组及严重静脉曲张组,再对上述指标采用非条件Logistic回归模型进行分析,筛选出有预测价值的食管静脉曲张及其程度的无创指标。结果:(1)对患者肝功能进行Child-Pugh分级,其中Child A级94例(45.6%)、B级81例(39.3%)、C级31例(15.0%);所有患者中,存在食管静脉曲张152例(73.8%),其中轻度曲张48例(23.3%)、中度曲张62例(30.1%)、重度曲张42例(20.4%),严重曲张(中度和重度曲张之和)共104例(50.5%)。(2)与门静脉高压相关的指标,如血小板、白细胞计数及门静脉直径和脾长,无论是所有静脉曲张组还是严重曲张组,与无曲张组比较均差异显著(P<0.05),而清蛋白、凝血时间、谷草转氨酶和胆红素各组间均差异不显著(P>0.05)。血小板、门静脉直径和脾长等相关因素均进入最终回归分析模型。结论:监测乙肝肝硬化患者血小板、白细胞计数及门静脉直径和脾长变化,有助于预测食管静脉曲张或严重食道静脉曲张的存在。
Objective: To investigate the noninvasive predictive value of esophageal varices in patients with hepatitis B cirrhosis. Methods: A total of 206 patients with hepatitis B cirrhosis admitted in our hospital from January 2007 to January 2012 were enrolled in this study. The general characteristics, clinical manifestations, biochemical parameters and ultrasound results of the patients were selected as the research parameters. According to the results of gastroscopy, Varicose vein group, all varicose veins group and severe varicose vein group, and then using the non-conditional logistic regression model to analyze the above indicators, screening predictive value of esophageal varices and the extent of noninvasive indicators. Results: (1) The Child-Pugh classification of liver function in patients, including Child A grade 94 cases (45.6%), B grade 81 cases (39.3%), C grade 31 cases (15.0%); Fifty-two patients (73.8%) had varicose veins, including 48 cases (23.3%) of mild varices, 62 cases (30.1%) of moderate varices, 42 cases of severe varices (20.4%) and severe varices (sum of moderate and severe varices) A total of 104 cases (50.5%). (2) The indices related to portal hypertension, such as platelet count, white blood cell count, portal vein diameter and spleen length, were significantly different between all varicose veins group and severe varicose vein group (P <0.05), while albumin , Clotting time, aspartate aminotransferase and bilirubin were not significantly different between groups (P> 0.05). Platelet, portal vein diameter and spleen length and other related factors are entering the final regression analysis model. Conclusions: Monitoring platelet and white blood cell count, portal vein diameter and spleen length in patients with hepatitis B cirrhosis can be helpful to predict the presence of esophageal varices or severe esophageal varices.