ZHANG Zhiqiang, CHEN Wei, LIU Bo / 临床肝胆病杂志

ABSTRACT

Objective To investigate the value of spleen volume (SV) in predicting portal hypertensive gastropathy (PHG) and severe PHG in patients with liver cirrhosis. Methods A retrospective analysis was performed for the clinical data of 168 patients with liver cirrhosis who were admitted to Xiangyang No.1 People's Hospistal Affiliated to Hubei University of Medicine from January 2018 to August 2022, and with the results of gastroscopy as the gold standard, these patients were divided into non-PHG group with 115 patients and PHG group with 53 patients; the PHG group was further divided into mild PHG group with 26 patients and severe PHG group with 27 patients. All patients underwent electronic gastroscopy, abdominal magnetic resonance imaging, and serological examination to obtain related indices and parameters. The group t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A multivariate Logistic regression analysis was used to screen out the independent risk factors for PHG and severe PHG, and the receiver operating characteristic (ROC) curve was used to compare the predictive value of related indices or parameters. The area under the Roccurve is compared using Delong test. Results The univariate analysis showed that there were significant differences between the PHG group and the non-PHG group in sex, presence or absence of ascites, hemoglobin (Hb), platelet count (PLT), aspartate aminotransferase, total bilirubin, albumin (Alb), prothrombin time, international normalized ratio, Child-Pugh class, FIB-4 score, King score, Lok score, spleen diameter (SD), SV, platelet count/spleen diameter ratio (PSDR), and platelet count/spleen volume ratio (PSVR) (all P < 0.05), and there were significant differences in Hb, PLT, Alb, SD, SV, PSDR, and PSVR between the mild PHG group and the severe PHG group (all P < 0.05). The multivariate Logistic regression analysis showed that FIB-4 score (odds ratio [ OR ]=1.280, 95% confidence interval [ CI ] 1.009-1.625, P < 0.05) and SV ( OR =1.007, 95% CI 1.001-1.013, P < 0.05) were independent risk factors for PHG, and SV ( OR =0.990, 95% CI 0.980-1.000, P < 0.05) was an independent influencing factor for severe PHG. The ROC curve analysis showed that in predicting PHG, SV had a larger area under the ROC curve (AUC) than FIB-4 score (0.884 vs 0.825, P < 0.05), with a sensitivity of 0.774 and a specificity of 0.870 at the optimal cut-off value of 406.82; in predicting the onset of severe PHG, SV had an AUC of 0.782, with a sensitivity of 0.593 and a specificity of 0.962 at the optimal cut-off value of 714.63. Conclusion SV has a good value in predicting the onset of PHG and severe PHG.