Amaç: Bu çalışmanın amacı, kompanse sirozu kronik hepatitten ayırmada platelet sayısı ve ultrasonografik dalak alanının değerini araştırmaktır. Gereç ve Yöntem: Bu çalışmaya karaciğer sirozlu 92 hasta, kronik hepatitli 73 hasta ve 91 sağlıklı kontrol alındı. Kompanse sirozu kronik hepatitten ayırmada platelet sayısı ve dalak alanının cut off değerleri receiver operating curves analizi ile saptandı. Bulgular: Ortalama platelet seviyesi karaciğer sirozu hastalarında 109.6±43 K/μL, kronik hepatit hastalarında 237.3±45 K/μL, sağlıklı kontrollerde ise 296.1±52 K/μL olarak saptandı. Platelet seviyesi her iki hasta grubunda da sağlıklı kontrollere göre anlamlı oranda düşüktü (p
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.
1. von Frerichs FT. Uber den Diabetes Berlin: Hirschwald;1884.
2. Sherlock S, Dooley J. Diseases of the Liver and Biliary System, 9th ed. Oxford: Blackwell Sci Pub, 1993: 39-41.
3. Colombo M, Del Ninno E, De Franchis R, et al. Ultrasound-assited liver biopsy: superiority of the Trucut over the Menghini needle for diagnosis of cirrhosis. Gastroenterology 1988; 95: 487-9.
4. Garcia-Tsao G, Boyer JL. Outpatient liver biopsy: how safe is it? Ann Intern Med 1993; 118: 150-3.
5. Soloway RD, Baggenstoss AH, Schoenfield LJ, Summerskill WH. Observer error and sampling variability tested in evaluation of hepatitis and cirrhosis by liver biopsy. Dig Dsi Sci 1971; 16: 1082-6.
6. Pagliaro L, Rinaldi F, Craxi A, et al. Percutaneous blind biopsy versus laparoscopy with guided biopsy in diagnosis of cirrhosis. A prospective, randomized trial. Dig Dsi Sci 1983; 28: 39-3.
7. Sanford NL, Walsh P, Matis C, et al. Is ultrasonography useful in the assessment of diffuse parenchymal liver disease? Gastroenterology 1985;89:186-91.
8. Joseph AE, Saverymuttu SH, Al-Sam S, et al. Comprasion of liver histology with ultrasonography in assessing diffuse parenchymal liver disease. Clin Radiol 1991; 43: 26-31.
9. Taylor KJ, Gorelick FS, Rosenfield AT, Riely CA. Ultrasonography of alcoholic liver disease with histological correlation. Radiology 1981;141:157-61.
10. Di Lelio A, Cestari C, Lomazzi A, Baretta L. Cirrhosis: diagnosis with sonographic study of liver surface. Radiology 1989; 172: 389-92.
11. Aster RH. Pooling of. platelets in the spleen: role in the pathogenesis of 'hypersplenic' thrombocytopenia. J Clin Invest 1966; 45: 645-57.
12. Martin-TG 3rd, Somberg KA, Meng YG, et al. Thrombopoietin levels in patients with cirrhosis before and after orthotopic liver transplantation Ann Intern Med 1997; 127: 285-8.
13. Desmet VJ, Gerber M, Hoofnagle JH, et al. Classification of chronic hepatitis: diagnosis, grading and staging. Hepatology 1994; 19: 1513-20.
14. Knodell RG, Ishak KG, Black WC, et al. Formulation and application of a numerical scoring system for assessing histological activity in. asymptomatic chronic active hepatitis. Hepatology. 1981; 1: 431-5.
15. Koga T. Correlation between sectional area of the spleen by ultrasonic tomography and actual volume of the removed spleen. J Clin Ultrasound 1979; 7: 119-20.
16. Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oe-sophagus for bleeding esophageal varices. Br J Surg 1973; 60: 646- 9.
17. Richard P, Bonniaud P, Barthelemy C, et al. Value of ultrasonography in the diagnosis of cirrhosis. Prospective study of 128 patients. J Radiol 1985; 66: 503-6.
18. Seitz JF, Boustiere C, Maurin P, et al. Evaluation of ultrasonography in the diagnosis of cirrhosis. Retrospective studies of 100 consecutive tests. Gastroenterol Clin Biol 1983;7 :734-9
19. Aiello A, Calapristi I, Freni MA, et al. Assessment of portal hypertension in hepatic cirrhosis in relation to etiologic factors. Minerva Gastroenterol Dietol 1993; 39: 1-5.
20. Cioni G, Tincani E, D'Alimonte P, et al. Relevance of reduced portal flow velocity, low platelet count and enlarged spleen diameter in the non-invasive diagnosis of compansated liver cirrhosis. Eur J Med 1993; 2: 408-10.
21. Chalasani N, Imperiale TF, Ismail A, et al. Predictors of large esophageal varices in patients with cirrhosis. Am J Gastroenterol 1999; 94: 3285-91.
22. Shearman DJ, Finlayson NDC. Portal hypertension. In: Shearman DJ, Finlayson NDC, eds. Diseases of the gastrointestinal tract and liver. London: Churchill Livingstone, 1989: 809-40.
23. Schaffner A, Augustiny N, Otto RC, Fehr J. The hypersplenic spleen. A contractile reservoir of granulocytes and platelets. Arch Intern Med 1985;145:651-4.
24. Poynard T, Bedossa P, Metavir and Clinivir Cooperative Study Groups. Age and platelet count: a simple index for predicting the presence of histological lesions in patients with antibodies to hepatitis C virus. J Viral Hepat 1997; 4: 199-208.
25. Adinolfi LE, Giordano MG, Andreana A, et al. Hepatic fibrosis plays a central role in the pathogenesis of thrombocytopenia in patients with chronic viral hepatitis. Br J Haematol 2001; 113: 590-5.