中村 克也¹, 重田 浩一朗³, 平賀 真雄¹, 坂口 右己¹, 末永 雅子², 畠中 尚美², 小倉 真理子³, 藤崎 邦夫³

Katsuya NAKAMURA¹, Kouichirou SHIGETA³, Masao HIRAGA¹, Yuuki SAKAGUCHI¹, Masako SUENAGA², Naomi HATANAKA², Mariko OGURA³, Kunio FUJISAKI³

¹隼人町立医師会医療センター放射線室, ²隼人町立医師会医療センター臨床検査室, ³隼人町立医師会医療センター消化器内科

¹Department of Radiology, Hayato Medical Center, ²Department of Clinical Laboratory, Hayato Medical Center, ³Department of Gastroenterology, Hayato Medical Center

キーワード : chronic liver disease, esophageal varices, noninvasive parameter, ultrasound

目的：慢性肝疾患患者では食道胃静脈瘤の管理は重要な問題である. その有無は内視鏡検査にて評価する事が一般的であるが, 血液検査や超音波検査等を用いて非侵襲的に食道静脈瘤の存在予測が行えないかを検討した. 対象および方法：対象は当院にて平成15年6月-平成16年3月までの10ヵ月間に上部消化管内視鏡検査を受けた慢性肝疾患患者110例(男性60例, 女性50例, 平均年齢64.7歳). 肝疾患の原因はアルコール性9例(8.2%), B型12例(10.9%), C型76例(60.9%), B非C型4例(3.6%), その他9例(8.2%). 全ての患者の消化管内視鏡所見, 血液生化学検査, 超音波所見(脾臓長径, Spleen Index, 門脈径)をretrospectiveに検索し, 食道胃静脈瘤と最も関連の深い因子を検討した. 結果：食道胃静脈瘤の合併は43例(39.1%)でみられ, 食道胃静脈瘤の有無で有意差を認めたのは, 1) 血小板数, 2) 血小板数/脾臓長径比, 3) 血小板数/Spleen Index比であった. 中でもよく相関したのは血小板数/脾臓長径比であり, cut off値を1410以下とすると, sensitivity 95%, specificity 61%であった. 結語：慢性肝疾患患者の食道胃静脈瘤の存在を予測するのに, 血小板数/脾臓長径比1410以下の指標が有用である可能性を示した.

Purpose: To identify clinical, biochemical and ultrasonographic parameters which might noninvasively predict the presence of esophageal and gastric varices in patients with chronic liver disease. Materials and Methods: We evaluated the presence of esophageal and gastric varices retrospectively in 110 patients with chronic liver diseases who had undergone gastroendoscopy from June 2003 through March 2004 at our institution. All these patients had undergone a complete blood count, blood chemistry workup and ultrasonic measurement of spleen bipolar diameter. The ratio of platelet count to spleen diameter was calculated for all patients. Results: The prevalence of esophageal and gastric varices among the patients was 39.1%. The two groups, those with and those without esophageal and gastric varices, differed significantly in platelet count, albumin concentration, spleen diameter, ratio of platelet count to spleen diameter, and ratio of platelet count to spleen index. A cutoff value of 1410 for the ratio of platelet count to spleen diameter had a sensitivity of 95 percent; specificity, 61 percent ; positive predictive value, 61 percent ; and negative predictive value, 95 percent. Conclusions: Ratio of platelet count to spleen diameter is a useful noninvasive indicator of the presence of esophageal and gastric varices in patient with chronic liver diseases.