Objective: To verify Baveno VI criteria, Expanded-Baveno VI criteria, liver stiffness×spleen diameter-to-platelet ratio risk score (LSPS), and platelet count/spleen diameter ratio (PSR) in evaluating the severity value of esophageal varices (EV) in patients with non-cirrhotic portal hypertension (NCPH). Methods: 111 cases of NCPH and 204 cases of hepatitis B cirrhosis who met the diagnostic criteria were included in the study. NCPH included 70 cases of idiopathic non-cirrhotic portal hypertension (INCPH) and 41 cases of nontumoral portal vein thrombosis (PVT). According to the severity of EV on endoscopy, they were divided into the low-bleeding-risk group (no/mild EV) and the high-bleeding-risk group (moderate/severe EV). The diagnostic value of Baveno VI and Expanded-Baveno VI criteria was verified to evaluate the value of LSPS and PSR for EV bleeding risk severity in NCPH patients. The t-test or Mann-Whitney U test was used to compare the measurement data between groups. Comparisons between counting data groups were performed using either the χ2 test or the Fisher exact probability method. Results: Considering endoscopy was the gold standard for diagnosis, the missed diagnosis rates of low/high bleeding risk EVs in INCPH/PVT patients with Baveno VI and Expanded-Baveno VI criteria were 50.0%/30.0% and 53.8%/50.0%, respectively. There were no statistically significant differences in platelet count (PLT), spleen diameter, liver stiffness (LSM), LSPS, and PSR between low-bleeding-risk and high-bleeding-risk groups in INCPH patients, and the area under the receiver operating characteristic curve (AUC) of LSPS and PSR was 0.564 and 0.592, respectively (P=0.372 and 0.202, respectively). There were statistically significant differences in PLT, spleen diameter, LSPS, and PSR between the low and high-bleeding risk groups in PVT patients, and the AUCs of LSPS and PSR were 0.796 and 0.833 (P=0.003 and 0.001, respectively). In patients with hepatitis B cirrhosis, the Baveno VI and Expanded-Baveno VI criteria were used to verify the low bleeding risk EV, and the missed diagnosis rates were 0 and 5.4%, respectively. There were statistically significant differences in PLT, spleen diameter, LSM, LSPS and PSR between the low-bleeding-risk and high-bleeding-risk groups (P<0.001). LSPS and PSR AUC were 0.867 and 0.789, respectively (P<0.05). Conclusion: Baveno VI and Expanded-Baveno VI criteria have a high missed diagnosis rate for EVs with low bleeding risk in patients with INPCH and PVT, while LSPS and PSR have certain value in evaluating EV bleeding risk in PVT patients, which requires further clinical research.
目的： 验证Baveno VI标准、Baveno VI扩大标准、肝硬度×脾脏长径/血小板计数评分（LSPS）和血小板计数与脾脏长径比值（PSR）对评估非肝硬化性门静脉高压（NCPH）患者食管静脉曲张（EV）严重程度的价值。 方法： 符合诊断标准的NCPH 111例和乙型肝炎肝硬化204例纳入研究，NCPH包括特发性非肝硬化性门静脉高压（INCPH）70例、慢性非肿瘤性非肝硬化门静脉血栓（PVT）相关门静脉高压症41例。根据内镜下EV严重程度，分为低出血风险组（无/轻度EV）和高出血风险组（中/重度EV）。验证Baveno VI和Baveno VI扩大标准对NCPH患者EV严重程度的诊断价值，评估LSPS、PSR对NCPH患者EV出血风险的诊断价值。计量资料组间比较采用t检验或Mann-Whitney U检验；计数资料组间比较采用χ2检验或Fisher确切概率法。 结果： 以内镜诊断为金标准，Baveno VI和Baveno VI扩大标准验证INCPH/PVT患者低/高出血风险EV的漏诊率分别为50.0%/30.0%和53.8%/50.0%。INCPH患者低出血风险与高出血风险组血小板计数（PLT）、脾脏长径、肝脏硬度（LSM）、LSPS和PSR测定的差异均无统计学意义，LSPS和PSR的受试者操作特征曲线下面积（AUC）分别为0.564、0.592（P值分别为0.372和0.202）。PVT患者低出血风险与高出血风险组PLT、脾脏长径、LSPS和PSR的差异有统计学意义，LSPS和PSR的AUC分别为0.796和0.833（P值分别为0.003和0.001）。乙型肝炎肝硬化患者，Baveno VI和Baveno VI扩大标准验证低出血风险EV，漏诊率分别为0、5.4%。低出血风险与高出血风险组PLT、脾脏长径、LSM、LSPS和PSR的差异均有统计学意义（P值均<0.001）。LSPS和PSR的AUC分别为0.867、0.789（P<0.05）。 结论： Baveno VI标准和Baveno VI扩大标准在INPCH和PVT患者低出血风险EV的漏诊率较高；LSPS和PSR对评估PVT患者EV出血风险具有一定价值，这还需要进一步临床研究。.