目的 测定门脉高压性胃病(portal hypertensive gastropathy,PHG)患者血清-腹水白蛋白梯度(serum ascites albumin gradient,SAAG),探讨PHG与SAAG之间的关系。方法 127例肝硬化并腹水病例分为PHG组与非PHG组,测量并比较两组SAAG;分析PHG组中SAAG与肝功能Child-Pugh分级、终末期肝病模型(MELD)评分、食管静脉曲张程度、门静脉直径及血小板计数/脾大小的关系;对PHG组中轻、重度情况下SAAG进行比较分析;绘制SAAG受试者工作特征(ROC)曲线,确定诊断PHG的SAAG最佳界限值。结果 PHG组与非PHG组的SAAG比较差异有统计学意义;PHG组的SAAG与Child-Pugh分级、MELD评分、食管静脉曲张程度呈正相关,不同水平SAAG的门静脉直径、血小板计数/脾大小比较差异有统计学意义;轻度PHG与重度PHG的SAAG比较差异有统计学意义;ROC曲线表明SAAG诊断PHG的最佳界值是18.57 g/L,敏感度和特异度分别为72.1%和93.2%。结论 SAAG反映了PHG病程中的门脉高压程度,对预测PHG的发生并判断其病情及预后有临床价值。
Abstract
Objective To study the serum ascites albumin gradient(SAAG) in patients with portal hypertensive gastropathy(PHG) and evaluate the relationship between PHG and SAAG. Method 127 patients with cirrhotic ascites were divided into PHG group and non-PHG group and their SAAG were comparatively analyzed. The relationship of SAAG between the Child-Pugh classification, MELD score, degree of esophageal varices, portal vein diameter and platelet count to spleen size ratio were analyzed in PHG group. The SAAG was analyzed contrastively on both mild and severe cases in PHG group. The receiver operating characteristic(ROC) curve was drawn to determine the optimal diagnosis threshold value of SAAG for PHG. Results The difference was statistically significant in SAAG between PHG group and non-PHG group. The SAAG was positively correlated with the Child-Pugh classification, MELD score and degree of esophageal varices in PHG group. Also there was statistical significance in diameter of portal vein and platelet count to spleen size ratio for SAAG at different levels, as well as the difference between mild and severe cases of SAAG. By using ROC curve, the optimal diagnosis threshold value of SAAG for PHG was shown to be 18.57 g/L, and sensitivity and specificity be 72.1% and 93.2%. Conclusions SAAG reflects the degree of portal hypertension in the course of PHG. SAAG is of clinical value for prediction of occurrence, judgment of the prognosis of PHG.
关键词
门脉高压性胃病 /
血清-腹水白蛋白梯度 /
肝硬化 /
终末期肝病模型 /
食管静脉曲张
Key words
portal hypertensive gastropathy /
serum ascites albumin gradient /
liver cirrhosis /
MELD /
esophageal varices
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Demacedo G F,Ferreira F G,Ribeiro M A,et al.Reliability in endscopic diagnosis of portal hypertensive gastropathy[J].World J Gastrointestndosc,2013,5(7):323-331.
[2] Emma L H.Targeting diureticuse for malignant ascites two case reports highlighting the value of the serum-ascites albumin gradientina palliative setting[J].Pain Sym Man,2010,39(2):7-9.
[3] Mc Cormack T T, Sima J, Eyre B L, et al. Gastriclesions in ortalhypertension: in flammatory gastritis or congestive gastropathy[J]. J Gut, 1985,26(4):1226-1232.
[4] 中华医学会消化病学分会,中华医学会肝病学分会,中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治共识(2008,杭州)[J].中华消化杂志,2008,28(8):551-558.
[5] 霍宏蕾,董培玲,范丽娟等.肝硬化门脉高压性胃病临床分析[J].北京医学,2012,34(3):219-220.
[6] 孙卫东,任普海,俞生富.血清腹水清蛋白梯度对腹水来源的鉴别诊断价值[J].交通医学,2009,23(5):535-553.[7] Khandwalla H E,Fasakin Y,El-Serag H B.The utility of evaluatinglow serum albumin gradient ascites in patients with cirrhosis[J].Am J Gastroenterol,2009,104(6):1401-1405.
[8] ZHEN Peilin,ZHANG Ying,ZHANG Yufeng,et al . Clinicalanalysis of liver cirrhosis with portal hypertensive gastropathy [J].J Prac Med,2010,26(16):3003-3005.
[9] Kumar A, Mishra S R, Sharma P, et al. Clinical,laboratory,and hemodynamic parameters in portal hypertensive gastropathy: A Study of 254 Cirrhotics[J].Clini Gastroenterol,2010,44(4):294-300.
[10] 林尤冠,孙 龙. 门脉高压性胃病相关危险因素分析[J].海南医学,2013,24(3):343-344.
[11] 毛 华,李 瑞.肝硬化门脉高压性胃病相关因素分析[J].实用医学杂志,2013,29(4):595-597.
[12] Qamar A A, Grace N D, Groszmann R J,et al. Platelet count is not apredictor of the presence or development of gastroesophagealvarices in cirrhosis[J]. J Hepatology,2008,47(6):153-159.
PDF(629 KB)
