New index to predict esophageal variceal bleeding in cirrhotic patients
New index to predict esophageal variceal bleeding in cirrhotic patients
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DOI：
10.3748/wjg.v20.i22.6989
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发表时间：
2014-06-14
影响因子：
4.3
通讯作者：
Wang, Wei-Jun
中科院分区：
文献类型：
--
作者：
Xu, Xiao-Dan;Dai, Jian-Jun;Wang, Wei-Jun
目的：目的：建立一种安全、简便、无创、经济的预测失代偿期肝硬化患者食管静脉曲张出血（EVB）的系统。方法：2008年5月至2011年3月，苏州大学附属常熟医院收治失代偿期肝硬化患者486例，男238例，女248例，平均年龄63.1 ± 11.2岁。入组本研究的患者接受超声多普勒（US-多普勒）评估胃左静脉（LGV）血流速度（LGVV）和血流方向（LGVBFD），并通过终末期肝病模型（MELD）评分系统进行评价。所有患者每三个月接受一次随访评估。结果：416例患者完成了平均31.6个月（范围：12至47个月）的随访评估。51例（12.3%）患者发生EVB。MELD评分在3个月内的变化（.MELD）、LGVV和LGVBFD与EVB的发生独立相关。MELDUS-多普勒指数（MUI）是一种新的指数，并使用以下逻辑回归方程计算：MUI = Logit（P）= 1.667（.MELD）+ 2.096（LGVV）-3.245（LGVBFD）-1.697。预测EVB发生的受试者工作特征曲线下面积在MUI组显著较高[0.858（95% CI：0.774-0.920）]比MELD [0.734（95%CI：0.636-0.817）; P < 0.05]，LGVV [0.679（95%CI：0.578-0.769）; P < 0.05]或LGVBFD [0.726（95%CI：0.627-0.810）; P < 0.05]单独使用。当MUI为46时，该指数诊断EVB的准确性为85.8%，特异性为80%，敏感性为87.27%。结论：MUI是一种无创、经济的指标，可用于预测失代偿期食管癌患者EVB的发生，并可作为传统内镜筛查下降时的一种替代方法。
AIM: To develop a safe, simple, noninvasive and affordable system to predict esophageal variceal bleeding (EVB) in decompensated cirrhosis patients.METHODS: Four hundred and eighty-six patients with decompensated cirrhosis (238 males and 248 females), with a mean age of 63.1 +/- 11.2 years, were admitted to Changshu Affiliated Hospital of Suzhou University between May 2008 and March 2011. Patients enrolled in this study underwent ultrasound-Doppler (US-Doppler) to assess left gastric vein (LGV) blood flow velocity (LGVV) and blood flow direction (LGVBFD), and were evaluated by the Model For End-Stage Liver Disease (MELD) scoring system. All patients received followup evaluations every three months. The resulting data were entered into a database after each time point collection.RESULTS: Four hundred and sixteen patients com-pleted follow-up evaluations for an average of 31.6 mo (range: 12 to 47 mo). Fifty-one (12.3%) patients experienced EVB. The change in the MELD score over three months (.MELD), LGVV and LGVBFD were independently associated with EVB occurrence. MELDUS- Doppler Index (MUI), a new index, was developed and calculated using the following logistic regression equation: MUI = Logit (P) = 1.667 (.MELD) + 2.096 (LGVV) -3.245 (LGVBFD) -1.697. The area under the receiver operating characteristic curve for prediction of EVB occurrence was significantly higher for the MUI [0.858 (95% CI: 0.774-0.920)] than for.MELD [0.734 (95% CI: 0.636-0.817); P < 0.05], LGVV [0.679 (95% CI: 0.578-0.769); P < 0.05] or LGVBFD [0.726 (95% CI: 0.627-0.810); P < 0.05] alone. When the MUI was set at 46, the index had high diagnostic accuracy (85.8%), with high specificity (80%) and sensitivity (87.27%).CONCLUSION: The MUI, a noninvasive and affordable index, can predict EVB occurrence in decompensated cirrhotic patients and serve as an alternative when conventional endoscopic screening is declined.