Aralik 2010
Kompanse siroz tanisinda platelet sayisi ve ultrasonografik dalak alaninin non-invaziv belirteç olarak degeri
The value of platelet count and ultrasonographic spleen size as non-invasive predictors of compensated cirrhosis
- Ana Sayfa
- Sayılar
- Aralik 2010
- Kompanse siroz tanisinda platelet sayisi ve ultrasonografik dalak alaninin non-invaziv belirteç olarak degeri...
Çukurova Üniversitesi Tip Fakültesi, 2Biyoistatistik Anabilim Dali, Adana
Özet
Amaç: Bu çalismanin amaci, kompanse sirozu kronik hepatitten ayirmada platelet sayisi ve ultrasonografik dalak alaninin degerini arastirmaktir. Gereç ve Yöntem: Bu çalismaya karaciger sirozlu 92 hasta, kronik hepatitli 73 hasta ve 91 saglikli kontrol alindi. Kompanse sirozu kronik hepatitten ayirmada platelet sayisi ve dalak alaninin cut off degerleri receiver operating curves analizi ile saptandi. Bulgular: Ortalama platelet seviyesi karaciger sirozu hastalarinda 109.6±43 K/μL, kronik hepatit hastalarinda 237.3±45 K/μL, saglikli kontrollerde ise 296.1±52 K/μL olarak saptandi. Platelet seviyesi her iki hasta grubunda da saglikli kontrollere göre anlamli oranda düsüktü (p<0.001 her ikisi için). Ortalama dalak alani ise karaciger sirozu ve kronik hepatit hastalarinda saglikli kontrollere göre anlamli olarak daha yüksekti (sirasiyla; 78.5±29 cm2, 43.9±14 cm2 ve 34.6±8 cm2) (p<0.001 her ikisi için). Platelet seviyesinin 179 K/μL?den daha düsük düzeyleri sirozu ayirmada %92.5 sensitivite ve %92 spesifisite ile en yüksek degere sahipti. Dalak alani da 56.5 cm2?nin üzerinde ise sirozu ayirmadaki sensitivitesi %81.5 ve spesifitesi de %80?e ulasmaktaydi. Dalak alani >52 cm2 ve platelet sayisi <179 K/μL oldugu kombinasyonun sirozu ayirmadaki sensitivitesi %81.5, spesifisitesi %94.5?ti. Pozitif prediktif degeri, negatif prediktif degeri ve dogrulugu sirasiyla %94.9, %80.2 ve %87.2 idi. Sonuç: Platelet düzeyi kabul edilen alt limitlerin üstünde olsa bile dalak alani ile birlikte kompanse siroz varligini belirlemede kullanilabilir. Elde edilen sonuçlar bu iki parametrenin biyopsi yapmaksizin sirozu kronik hepatitten ayirmada kullanilabilecek belirteçler oldugunu göstermektedir.
Abstract
Background and Aims: The purpose of this study was to investigate the value of platelet level and spleen size for discrimination of compensated cirrhosis from chronic hepatitis. Methods: Ninety-two patients with liver cirrhosis, 73 patients with chronic hepatitis (CH) and 91 healthy controls were enrolled in this study. The cut-off values of peripheral platelet count and spleen area were determined for chronic hepatitis and liver cirrhosis by receiver operating curve analysis. Results: The mean platelet levels were significantly lower in liver cirrhosis and chronic hepatitis patients (mean±SD: 109.6±43 K/μL and 237.3±45 K/μL, respectively) compared with the controls (296.1±52 K/μL, p<0.001 for both). The mean spleen areas were significantly larger in liver cirrhosis and chronic hepatitis patients (78.5±29 cm2 and 43.9±14 cm2, respectively) compared with the controls (34.6±8 cm2, p<0.001 for both). A platelet count <179 K/μL had the highest discriminative value for cirrhosis, with a sensitivity of 92.5% and a specificity of 92%. A spleen area >56.5 cm2 had the highest discriminative value for cirrhosis, with a sensitivity of 81.5% and a specificity of 80%. Spleen area >52 cm2 and platelet count <179 K/μL had discriminative value for cirrhosis, with a sensitivity of 81.5% and a specificity of 94.5%. The positive predictive value, negative predictive value and accuracy were 94.9%, 80.2% and 87.2%, respectively. Conclusions: A platelet level even above the commonly accepted lower limit and spleen size can be used to predict the presence of compensated cirrhosis; in other words, to differentiate cirrhosis from chronic hepatitis without biopsy.
