论文部分内容阅读
目的 分析预测肝炎肝硬化患者食管静脉曲张的无创指标,并建立模型预测食管静脉曲张程度. 方法 根据胃镜检查结果将294例肝炎肝硬化门静脉高压症患者按食管静脉曲张程度分为两组,即无或轻度曲张组、中重度曲张组.对肝脏硬度值、血小板计数、脾脏厚度、血小板计数/脾脏厚度比值、门静脉直径、门静脉血流速度、Child-Pugh评分进行单因素分析和logistic回归分析,筛选出可以有效预测食管静脉曲张及其程度的无创指标,并在此基础上构建预测模型.计量资料采用t检验,计数资料应用x2检验,多因素分析采用logistic回归分析,应用受试者工作特征曲线分析方法评价模型的诊断价值并确定界值.结果 建立的无创预测模型受试者运行曲线显示,ROC曲线下面积为0.990,以积分0.898为界值,诊断的敏感性为96.5％,特异性为99.2％. 结论 由肝脏硬度、脾脏厚度、血小板计数、血小板计数/脾脏厚度、Child-Pugh评分五个无创指标建立的预测模型预测食管静脉曲张准确、敏感,具有一定临床应用价值.“,”Objective To analyze the non-invasive indexes for predicting esophageal varices (EV) in liver cirrhosis,and to establish a model for predicting the degree of EV.Methods A total of 294 patients with liver cirrhosis and portal hypertension were divided into the following groups according to EV grade as assessed by endoscopy:non-EV and grade Ⅰ EV,grade Ⅱ EV and grade Ⅲ EV.The non-invasive EV predictive measures of liver stiffness (LS),platelet (PLT) count,spleen thickness (ST),PLT/ST ratio,portal vein diameter,portal vein flow velocity and Child-Pugh score (CPS) were assessed by univariate analysis and multivariate logistic regression analysis,and used to generate a predictive model.The t-test,chi-square test,logistic analysis and receiver operating characteristic (ROC) curve were used in statistical analyses.Results The area under the ROC for the new model was 0.990.The best cutoff value for the score was 0.898,as defined from the ROC.The sensitivity of the model was 96.5％,and the specificity was 99.2％.Conclusions The model for predicting EV was composed ofLS,PLT count,ST,PLT/ST and CPS,which was accurate and sensitive,and could be used to predict EV in clinic.