Research Article
SİROZLU HASTALARDA ÖZOFAGUS VARİSİNİ PREDİKTE EDEN NON-İNVAZİF, BASİT VE YENİ BİR BELİRTEÇ: TROMBOSİT SAYISI/DALAK BOYUTU ORANI A Non-Invasive Simple And New Marker Predicting Esophageal Varices In Cirrhotic Patients: Platelet Count/ Spleen Size Ratio
Abstract
ÖZET
Amaç: Özofagus varisleri siroz hastalarında portal hipertansiyonun ciddi bir sonucudur. Varisleri
değerlendirmede endoskopi en sık kullanılan yöntemdir. Çalışmamızda kronik hepatit B ve/veya hepatit C’ye
bağlı karaciğer sirozu olan hastalarda özofagus varislerinin varlığı ve derecesinin öngörülmesinde noninvaziv
parametreler değerlendirildi.
Gereç ve Yöntemler: Çalışmaya 2009-2015 yılları arasında Gaziantep Üniversitesi Tıp Fakültesi Gastroenteroloji
Bilim Dalı’nda takip edilen, hepatit B ve/veya hepatit C virüsü nedeniyle karaciğer sirozu tanısı konulan 324
hasta alındı. Hastaların demografik, klinik, laboratuvar, radyolojik (dalak boyutu, portal ven çapı, portal ven
akımı) ve endoskopik bulguları retrospektif olarak dosya taraması ile elde edilerek varis ile ilişkisi değerlendirildi.
Bulgular: Çalışmaya alınan 324 hastanın 178 (%54.9)’i erkek, 146 (%45.1)’sı kadın olup yaş ortalaması 57.4±11.2
(27-87) idi.164’ü kronik hepatit B, 160’ı ise kronik hepatit C’ye bağlı siroz idi. Hastaların 69 (%21.3)’unda
özofagus varisi saptanmazken, 255 (%78.7) hastada özofagus varisi mevcuttu. 255 hastanın 97 (%29.9)’sinde
grade 1, 129 (%39.8)’unda grade 2, 29 (%9.0)’unda ise grade 3 özofagus varisi görüldü. Özofagus varisi olan
ve olmayan gruplar arasında dalak boyutu, portal ven çapı, trombosit sayısı, trombosit sayısı/dalak boyutu
oranı arasında anlamlı fark bulundu (p=0001). Varis varlığını predikte eden trombosit sayısı/dalak boyutu oranı
cutoff değeri ?846 (sensitivite %90, spesifite %91) olarak saptandı. Trombosit sayısı/dalak boyutu oranı 846 ve
altındaki değerler için varis varlığını göstermedeki pozitif prediktif değeri %97.4 olup negatif prediktif değeri
%71.5 bulundu.
Sonuç: Sirozlu hastalarda özofagial varis varlığını yüksek sensitivite ve spesifitesi ile predikte edebilecek bir
parametre olarak trombosit sayısı/dalak boyutu oranı yeni ve non-invaziv bir belirteç olarak kullanılabilir.
Anahtar Sözcükler: Siroz; Portal hipertansiyon; Özofagus varisi; Non- Invaziv belirteç
ABSTRACT
Aim: Esophageal varices are a serious consequence of portal hypertension in patients with liver cirrhosis.
Endoscopy is the most commonly used method for the evaluation of esophageal varices. The aim of this study
is to evaluate non- invasive predictors of presence and size of esophageal varices in chronic hepatitis B or C
positive liver cirrhosis patients.
Material and Methods: 324 cirrhotic patients with hepatitis B or C who applied to Gastroenterology clinic
of Gaziantep University between the years of 2009-2015 were included in the study. Demographic, clinical,
laboratory, radiological (spleen size, portal veindiameter, portal flow), and endoscopic (presence and size
of esophageal varices) findings were obtained from the patients files as retrospectively. The relationship
between presence of varices and laboratory/radiological findings were assessed.
Results: A total of 324 patients were included. The mean age was 57.4±11.2 years; 178 (54.9%) were men, and
146 (45.1%) women. 164 patients were chronic hepatitis B related cirrhosis and 160 were chronic hepatitis
C related cirrhosis. Esophageal varices were present in 255 (78,7%) patients and in 69 patients (21.3%) had
no esophageal varices. Out of 255 patients, 97 (29.9%) had grade 1, 129 (%39.8) grade 2, 29 (%9) grade 3
varices. Spleen size, portal vein diameters, platelet count and platelet count/spleen size ratio had statistically
significant difference in varices group when compared with the non-varix group (p=0001). In the estimation
of varices; cut off value of platelet count/spleen size ratio was found as ?846 with sensitivity of 90 %, and
specificity of 91 %, positive and negative predictive values of 97,4% and 71,5%, respectively.
Conclusion:The ratio of platelet count / spleen size as a parameter with high sensitivity and specificity which
can predict the presence of esophageal varices in patients with cirrhosis, can be used as a new and noninvasive
marker.
KeyWords: Cirrhosis; Portal hypertension; Esophageal varix; Non-Invasive marker
References
- 1. Popper H. Pathologic aspects of cirrhosis. Am J Pathol. 1977;87(1):228-264. 2. Sherlock S, Dooley J. Hepatic cirrhosis. In: Disease of the liver disease and biliary system. 2th ed, London, Blackwell scientific pub. 2002;371. 3. Graham DY, Smith JL. The course of patients after variceal hemorrhage. Gastroenterology 1981;80:800-809. 4. De Franchis R, on behalf of the Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010;53:762-768. 5. Wyllie R, Kay M. Esophagogastroduodenoscopy, colonoscopy and related techniques. In: Pediatric gastrointestinal disease. Wyllie R, Hyams JS (eds). Philadelphia, Saunderscompany. 1993;966-998. 6. Giannini E, Zaman A, Kreil A, Floreani A, Dulbecco P, Testa E, et al. Platelet count/ spleen diameter ratio for the non invasive diagnosis of esophageal varices: results of a multicenter, prospective, validation study. Am J Gastroenterol. 2006;101:2511-2519. 7. Kazemi F, Kettaneh A, N’kontchou G, Pinto E, Ganne-Carrie N, Trinchet JC, et al. Liver stiffness measurement selects patients with cirrhosis at risk of bearing large oesophageal varices. J Hepatol. 2006;45:230-235. 8. Perri RE, Chiorean MV, Fidler JL, Fletcher JG, Talwalkar JA, Stadheim L, et al. A prospective evaluation of computerized tomographic (CT) scanning as a screening modality for esophageal varices. Hepatology. 2008;47:1587-1594. 9. Beppu K, Inokuchi K, Koyanagi N, Nakayama S, Sakata H, Kitano S, Kobayashi M. Prediction of varicealhemorrhagebyesophagealendoscopy. GastrointestEndosc. 1981 Nov;27(4):213-8. 10. Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg.1973;60:646–649
Year 2019,
Volume: 9 Issue: 3, 56 - 64, 16.09.2019
Abstract
References
- 1. Popper H. Pathologic aspects of cirrhosis. Am J Pathol. 1977;87(1):228-264. 2. Sherlock S, Dooley J. Hepatic cirrhosis. In: Disease of the liver disease and biliary system. 2th ed, London, Blackwell scientific pub. 2002;371. 3. Graham DY, Smith JL. The course of patients after variceal hemorrhage. Gastroenterology 1981;80:800-809. 4. De Franchis R, on behalf of the Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010;53:762-768. 5. Wyllie R, Kay M. Esophagogastroduodenoscopy, colonoscopy and related techniques. In: Pediatric gastrointestinal disease. Wyllie R, Hyams JS (eds). Philadelphia, Saunderscompany. 1993;966-998. 6. Giannini E, Zaman A, Kreil A, Floreani A, Dulbecco P, Testa E, et al. Platelet count/ spleen diameter ratio for the non invasive diagnosis of esophageal varices: results of a multicenter, prospective, validation study. Am J Gastroenterol. 2006;101:2511-2519. 7. Kazemi F, Kettaneh A, N’kontchou G, Pinto E, Ganne-Carrie N, Trinchet JC, et al. Liver stiffness measurement selects patients with cirrhosis at risk of bearing large oesophageal varices. J Hepatol. 2006;45:230-235. 8. Perri RE, Chiorean MV, Fidler JL, Fletcher JG, Talwalkar JA, Stadheim L, et al. A prospective evaluation of computerized tomographic (CT) scanning as a screening modality for esophageal varices. Hepatology. 2008;47:1587-1594. 9. Beppu K, Inokuchi K, Koyanagi N, Nakayama S, Sakata H, Kitano S, Kobayashi M. Prediction of varicealhemorrhagebyesophagealendoscopy. GastrointestEndosc. 1981 Nov;27(4):213-8. 10. Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg.1973;60:646–649
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Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Original Research |
| Authors | |
| Publication Date | September 16, 2019 |
| Published in Issue | Year 2019 Volume: 9 Issue: 3 |
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