Buğra Tolga KONDUK, Fikri ŞİRİN, Murat Taner GÜLŞEN

SİROZLU HASTALARDA ÖZOFAGUS VARİSİNİ PREDİKTE EDEN NON-İNVAZİF, BASİT VE YENİ BİR BELİRTEÇ: TROMBOSİT SAYISI/DALAK BOYUTU ORANI

Amaç: Özofagus varisleri siroz hastalarında portal hipertansiyonun ciddi bir sonucudur. Varislerideğerlendirmede endoskopi en sık kullanılan yöntemdir. Çalışmamızda kronik hepati B ve/veya hepati C’yebağlı karaciğer sirozu olan hastalarda özofagus varislerinin varlığı ve derecesinin öngörülmesinde noninvazivparametreler değerlendirildi.Gereç ve Yöntemler: Çalışmaya 2009-2015 yılları arasında Gaziantep Üniversitesi Tıp Fakültesi GastroenterolojiBilim Dalı’nda takip edilen, hepati B ve/veya hepati C virüsü nedeniyle karaciğer sirozu tanısı konulan 324hasta alındı. Hastaların demografi, klinik, laboratuvar, radyolojik (dalak boyutu, portal ven çapı, portal venakımı) ve endoskopik bulguları retrospekti olarak dosya taraması ile elde edilerek varis ile ilişkisi değerlendirildi.Bulgular: Çalışmaya alınan 324 hastanın 178 (%54.9)’i erkek, 146 (%45.1)’sı kadın olup yaş ortalaması 57.4±11.2(27-87) idi.164’ü kronik hepati B, 160’ı ise kronik hepati C’ye bağlı siroz idi. Hastaların 69 (%21.3)’undaözofagus varisi saptanmazken, 255 (%78.7) hastada özofagus varisi mevcutt. 255 hastanın 97 (%29.9)’sindegrade 1, 129 (%39.8)’unda grade 2, 29 (%9.0)’unda ise grade 3 özofagus varisi görüldü. Özofagus varisi olanve olmayan gruplar arasında dalak boyutu, portal ven çapı, trombosit sayısı, trombosit sayısı/dalak boyutuoranı arasında anlamlı fark bulundu (p=0001). Varis varlığını predikte eden trombosit sayısı/dalak boyutu oranıcutof değeri ≤846 (sensitiite %90, spesifie %91) olarak saptandı. Trombosit sayısı/dalak boyutu oranı 846 vealtıdaki değerler için varis varlığını göstermedeki poziti predikti değeri %97.4 olup negati predikti değeri%71.5 bulundu.Sonuç: Sirozlu hastalarda özofagial varis varlığını yüksek sensitiite ve spesifiesi ile predikte edebilecek birparametre olarak trombosit sayısı/dalak boyutu oranı yeni ve non-invaziv bir belirteç olarak kullanılabilir.

A Non-Invasive Simple And New Marker Predictig Esophageal Varices In Cirrhoti Patints: Platelet Count/ Spleen Size Rati

Aim: Esophageal varices are a serious consequence of portal hypertension in patints with liver cirrhosis. Endoscopy is the most commonly used method for the evaluatin of esophageal varices. The aim of this study is to evaluate non- invasive predictors of presence and size of esophageal varices in chronic hepatii B or C positie liver cirrhosis patints. Material and Methods: 324 cirrhoti patints with hepatii B or C who applied to Gastroenterology clinic of Gaziantep University between the years of 2009-2015 were included in the study. Demographic, clinical, laboratory, radiological (spleen size, portal veindiameter, portal flw), and endoscopic (presence and size of esophageal varices) fidings were obtained from the patints fies as retrospectiely. The relatinship between presence of varices and laboratory/radiological fidings were assessed. Results: A total of 324 patints were included. The mean age was 57.4±11.2 years; 178 (54.9%) were men, and 146 (45.1%) women. 164 patints were chronic hepatii B related cirrhosis and 160 were chronic hepatii C related cirrhosis. Esophageal varices were present in 255 (78,7%) patints and in 69 patints (21.3%) had no esophageal varices. Out of 255 patints, 97 (29.9%) had grade 1, 129 (%39.8) grade 2, 29 (%9) grade 3 varices. Spleen size, portal vein diameters, platelet count and platelet count/spleen size rati had statitially signifiant diffrence in varices group when compared with the non-varix group (p=0001). In the estiatin of varices; cut of value of platelet count/spleen size rati was found as ≤846 with sensitiity of 90 %, and specifiity of 91 %, positie and negatie predictie values of 97,4% and 71,5%, respectiely. Conclusion:The rati of platelet count / spleen size as a parameter with high sensitiity and specifiity which can predict the presence of esophageal varices in patints with cirrhosis, can be used as a new and noninvasive marker

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