Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis
Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis
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DOI：
10.1053/j.gastro.2012.10.001
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发表时间：
2013-01-01
期刊：
影响因子：
29.4
通讯作者：
Bosch, Jaime
中科院分区：
文献类型：
--
作者：
Berzigotti, Annalisa;Seijo, Susana;Bosch, Jaime
背景与目的：需要无创方法来识别代偿性肝硬化患者临床上明显的门静脉高压（CSPH）和食管静脉曲张（EVs）。我们在肝硬化患者中寻找CSPH和EVs存在的标志物。方法：我们进行了一项横断面研究，包括来自三级转诊中心经组织学证实的117例代偿性肝硬化患者的训练集。超声测量脾脏直径，瞬态弹性图测量肝脏刚度；以内窥镜检查为EVs检测标准，以肝静脉压梯度测定为CSPH鉴别标准。我们评估了血小板计数、脾脏直径、LS以及这些因素的组合（即血小板计数与脾脏大小之比，LS X脾脏大小/血小板计数[LSPS]）识别CSPH和EV患者的能力。分析纳入了2个新的统计模型：PH风险评分和静脉曲张风险评分。结果通过来自另一个中心的56例代偿患者的独立系列进行验证。结果：LS是鉴别CSPH患者的最佳单一无创变量（受试者操作特征下面积0.883；95%可信区间[CI] 0.824 ~ 0.943; P < 0.0001）。当LS与血小板计数和脾脏大小联合使用时，无论是LSPS （0.918, 95% CI, 0.872-0.965, P < 0.0001）还是PH风险评分（0.935,95% CI, 0.893-0.977, P < 0.0001），受试者工作特征值下的面积都有所增加。超过80%的患者使用LSPS和PH风险评分进行准确分类。静脉曲张风险评分和LSPS分析在识别EVs患者方面优于所有其他无创检查（受者操作特征下面积，0.909;95% CI, 0.841-0.954和0.882;95% CI, 0.810-0.935）；他们在训练集中正确分类了85%的患者，在验证集中正确分类了75%。结论：LS、脾直径和血小板计数的综合数据可用于识别最有可能合并CSPH和EV的代偿性肝硬化患者。
BACKGROUND & AIMS: Noninvasive methods are needed to identify clinically significant portal hypertension (CSPH) and esophageal varices (EVs) in patients with compensated cirrhosis. We looked for markers of the presence of CSPH and EVs in patients with cirrhosis. METHODS: We performed a cross-sectional study that included a training set of 117 patients with compensated cirrhosis, confirmed by histology, from a tertiary referral center. Spleen diameter was measured by ultrasound, and liver stiffness (LS) was measured by transient elastography; endoscopy was used as the standard for detection of EVs, and measurements of hepatic venous pressure gradient were used as the standard for identifying CSPH. We assessed the ability of platelet count, spleen diameter, LS, and combinations of these factors (ie, ratio of platelet count to spleen size, and LS X spleen size/platelet count [LSPS]) to identify patients with CSPH and EV. The analysis included 2 new statistical models: the PH risk score and the varices risk score. Results were validated using an independent series of 56 patients with compensated patients from another center. RESULTS: LS was the best single noninvasive variable for identifying patients with CSPH (area under the receiver operating characteristic, 0.883; 95% confidence interval [CI], 0.824-0.943; P < .0001). The area under the receiver operating characteristic value increased when LS was combined with platelet count and spleen size, either as LSPS (0.918; 95% CI, 0.872-0.965; P < .0001) or PH risk score (0.935; 95% CI, 0.893-0.977; P < .0001). More than 80% of patients were accurately classified using LSPS and PH risk score. Analyses of the varices risk score and LSPS were superior to all other noninvasive tests for identifying patients with EVs (area under the receiver operating characteristic, 0.909; 95% CI, 0.841-0.954 and 0.882; 95% CI, 0.810-0.935, respectively); they correctly classified 85% of patients in the training set and 75% in the validation set. CONCLUSIONS: Combined data on LS, spleen diameter, and platelet count can be used to identify patients with compensated cirrhosis most likely to have CSPH and EV.