不同非侵入性标记物预测肝硬化患者食管静脉曲张出血的效能分析

摘要/Abstract

摘要： 目的: 评估不同非侵入性标记物预测肝硬化患者食管静脉曲张出血(esophageal varices blooding,EVB)的效能。方法: 2016年1月至2019年2月,纳入了在6个月内接受CT和上消化道胃镜检查的86例肝硬化患者。通过ROC曲线评估瞬时弹性成像技术(FibroScan)、天冬氨酸转氨酶(AST)与丙氨酸转氨酶(ALT)比值(AST/ALT)、AST与血小板比值指数(APRI)、血小板计数与脾脏直径(PL/SD)、纤维化指数-4(FIB-4)、纤维化指数、King评分对EVB的诊断性能。结果: 在86例肝硬化患者中,有21例出现EVB,发生率为24.4%。与非EVB组相比,EVB组患者的血红蛋白显著降低(P<0.05),而FibroScan值显著升高(P<0.05)。ROC分析结果显示,FibroScan值在预测EVB方面具有最高的特异性(75.3%)、PPV(51.3%)、AUC(0.70)和准确度(70.2%)。logistic回归分析显示,EVB与FibroScan值之间存在显著相关性(OR=1.57;95%CI:1.15-2.14),而其他非侵入性标记物(纤维化指数、King评分、APRI、PL/SD和AST/ALT)未显示与EVB存在显著关联。结论: FibroScan值是肝硬化患者EVB最可靠的预测因子。尽管诊断准确率低,FibroScan值是最有效的非侵入性肝纤维化标志物,可作为EVB的初步筛查工具。

关键词: 食管静脉曲张, 肝硬化, 非侵入性生物标志物, 静脉曲张出血

Abstract: Objective To investigate the efficiency of different non-invasive markers in predicting esophageal variceal bleeding (EVB) in liver cirrhotic patients. Methods From January 2016 to February 2019, 86 patients with cirrhosis who underwent CT and upper gastrointestinal endoscopy examinations within six months were included. The diagnostic performances of instantaneous elastography (FibroScan), aspartate aminotransferase (AST) to alanine aminotransferase (ALT), AST to platelet ratio index (APRI), platelet count and spleen diameter (PL/SD), fibrosis index-4 (FIB-4), fibrosis index and King’s score were assessed by the receiver operating characteristic curve (ROC curve). Results Twenty one of the 86 cirrhotic patients had EVB (24.4%). Compared with non-EVB group, hemoglobin in the patients of EVB group decreased significantly (P<0.05), whereas liver stiffness measured by Fibroscan increased significantly (P<0.05). ROC analysis showed that FibroScan stiffness had the highest specificity (75.3%), PPV (51.3%), AUC (0.70) and accuracy (70.2%) in predicting EVB. Logistic regression analysis showed that there was a significant correlation between EVB and Fibroscan stiffness (OR = 1.57; 95%CI: 1.15-2.14), while other non-invasive markers (fibrosis index, King score, APRI, PL/SD and AST/ALT) did not significantly correlate with EVB. Conclusion Liver stiffness measured by FibroScan is the most reliable predictor of EVB in patients with liver cirrhosis. Despite the low diagnostic accuracy, liver stiffness is the most efficient non-invasive marker which may be used as an initial screening tool for EVB.

Key words: Esophageal varices, Liver cirrhosis, Non-invasive biomarkers, Variceal bleeding

黄显光, 李松湖, 黄玫婷, 吴光耀, 张富, 岑晓红. 不同非侵入性标记物预测肝硬化患者食管静脉曲张出血的效能分析[J]. 肝脏, 2020, 25(7): 724-728.

HUANG Xian-guang, LI Song-hu, HUANG Mei-ting, WU Guang-yao, ZHANG Fu, CEN Xiao-hong. Prediction of esophageal variceal bleeding in patients with hepatic cirrhosis by different non-invasive markers[J]. Chinese Hepatolgy, 2020, 25(7): 724-728.

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