Neinvazivna procena postojanja i veličine varikoziteta jednjaka
Sažetak
Uvod/Cilj. Znatan broj bolesnika sa cirozom jetre podvrgnutih „skrining“ endoskopiji nema ezofagealne varikozitete (EV) ili ima EV za koje nije potrebna profilaktička terapija. Imajući u vidu invazivnost te procedure, razumljiva je potreba za razvojem neendoskopskih metoda za procenu prisustva EV. Cilj rada bio je da se utvrdi značaj kliničkih, biohemijskih i ultrazvučnih parametara u predviđanju EV. Metode. U istraživanje je bilo uključeno 59 bolesnika sa cirozom jetre, 39 (66,1%) bolesnika sa EV i 20 (33,9%) bolesnika bez EV. U grupi bolesnika sa EV 22 (56,4%) bolesnika imalo je male EV, a 17 (46,3%) bolesnika velike EV. Procenjivani su klinički parametri, koji su uključivali Child-Pugh (CP) klasu, prisustvo ascita i splenomegaliju. Svim ispitanicima urađeni su kompletna krvna slika, testovi funkcije jetre, ultrazvuk abdomena, gastroskopija i izračunat je odnos broja trombocita/dijametra slezine (platelet count/spleen diameter – PC/SD). Rezultati. Univarijanta logistička regresiona analiza pokazala je da su nezavisni faktori rizika od pojave EV bili: CP B klasa [odds ratio (OR) 6,67; p = 0,003] i CP C klasa (OR 23,33; p = 0,005) u odnosu na klasu A, prisustvo ascita (OR 7,78; p = 0,001), veličina slezine (OR 1,035; p = 0,016), bilirubin (OR 1,065; p = 0,007), albumin (OR 0,794; p = 0,001), protrombinsko vreme (OR 0,912; p < 0,001), international normalized ratio-INR (OR 231,364; p < 0,001), broj trombocita (OR 0,989; p = 0,023) i odnos PC/SD (OR 0,999; p = 0,034). U multivarijantnom modelu pokazalo se da je statistički značajan faktor rizika od prisustva EV bio smanjenje broja trombocita (OR 0,983; p = 0,023). Utvrđeno je da su statistički značajni faktori rizika od pojave velikih EV bili leukopenija i veličina desnog lobusa jetre. Na osnovu receiver operating characteristic (ROC) krive za odnos PC/SD, dobijena je granična (cutoff) vrednost testa 907 (907,11), sa negativnom prediktivnom vrednošću od 76,4% za velike EV. Zaključak. Cutoff vrednost odnosa PC/SD < 907 ima prognostički značaj za pojavu velikih EV.
Reference
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