基于肝硬度值、脾脏直径和血小板的LSP评分对乙型肝炎肝硬化食管静脉曲张的评价

摘要/Abstract

摘要： 目的探讨PLT、透明质酸(HA)、层黏连蛋白(LN)、III型前胶原N端肽(PIIINP)、IV型胶原(CIV)、脾脏直径(SD)、肝脏硬度值(LSM)以及联合LSM、SD、PLT获得的LSP评分等肝纤维化指标对乙型肝炎肝硬化(HBC)患者食管静脉曲张(EV)的评价作用。方法回顾2019年1月—2022年3月在北大医疗淄博医院住院治疗的162例HBC患者资料,其中男105例、女57例,年龄54(40,76)岁。HBC符合诊断要求。依据胃镜情况进行EV分组。结果 162例HBC患者中无EV、轻中度EV以及重度EV分别为27例、59例及76例。无EV组、轻中度EV组和重度EV组PLT为122(76,140)×10⁹/L、76(56,102)×10⁹/L及58(44,81)×10⁹/L,差异具有统计学意义(P<0.05);无EV组HA、LN、PIIINP及CIV分别为258.2(105.6,580.5)、107.5(60.7,142.9)、14.0(6.8,17.2)及128.0(63.2,264.5)μg/mL,分别与轻中度EV组[352.4(167.0,627.8)、140.2(69.8,188.5)、16.2(7.3,33.5)及153.2(84.8,229.9)μg/mL]、重度EV组[640.2(290.2,918.7)、158.7(94.6,236.4)、19.6(9.5,47.5)及180.7(119.0,282.6)μg/mL]相比,差异具有统计学意义(P<0.05);无EV组、轻中度EV组和重度EV组SD为13.2(10.8,15.0)、14.4(11.4,16.0)及15.8(14.6,17.2)cm,差异具有统计学意义(P<0.05); 无EV组LSM及LSP评分分别为14.8(10.6,24.0)kPa及1.9(1.0,3.5)分,分别与轻中度EV组[24.7(17.8,29.5)kPa及4.6(2.4,7.2)分]、重度EV组[37.2(28.8,42.6)kPa及10.0(6.2,14.2)分]相比,差异具有统计学意义(P<0.05)。分析上述肝纤维化指标与EV程度的相关性,结果显示SD、LSM及LSPS与EV程度呈中度正相关(r=0.51、0.63及0.67,P<0.05),HA、LN、PIIINP及CIV与EV程度呈弱正相关(r=0.25、0.28、0.21及0.23,P<0.05),而PLT与EV程度呈中度负相关(r=-0.41,P<0.05)。PLT、HA、LN、PIIINP、CIV、SD、LSM及LSP评分诊断EV存在的AUC值分别为0.77、0.65、0.64、0.61、0.59、0.77、0.84及0.87;PLT、HA、LN、PIIINP、CIV、SD、LSM及LSP评分诊断重度EV的AUC值分别为0.71、0.64、0.59、0.62、0.60、0.77、0.84及0.86。结论 PLT、HA、LN、PIIINP、CIV、SD、LSM及LSP评分与HBC患者EV状态具有相关性,其中LSP评分对EV存在及重度EV的诊断效能较佳,对HBC患者治疗具有指导意义。

关键词: 慢性乙型肝炎, 肝硬化, 食管静脉曲张, 肝脏硬度值, 脾脏直径

Abstract: Objective To investigate the influence of paltelet (PLT), hyaluronic acid (HA), laminin (LN), type III procollagen N-terminal peptide (PIIINP), type IV collagen (CIV), spleen diameter (SD), liver hardness (LSM) and LSP score obtained by combining LSM, SD and PLT on esophageal varices (EV) in patients with hepatitis B virus (HBV) related cirrhosis.Methods The data of 162 patients with HBV related cirrhosis admitted to our hospital from January 2019 to March 2022 were reviewed, including 105 males and 57 females, aged 54 (40, 76) years. HBV related cirrhosis meets the diagnostic requirements. According to gastroscopy, patients withe EV were divided into different groups.Results Among the 62 patients with HBV related cirrhosis, 27 cases without EV, 59 cases with mild to moderate EV and 76 cases with severe EV, respectively. The PLT of no-EV group, mild to moderate EV group and severe EV group were 122 (76, 140) × 10⁹/L, 76 (56, 102) × 10⁹/L and 58 (44, 81) × 10⁹/L, the difference was statistically significant (P<0.05). HA, LN, PIIINP and CIV in the EV group were 258.2 (105.6, 580.5) μg/mL, 107.5 (60.7, 142.9) μg/mL, 14.0 (6.8, 17.2) μg/mL and 128.0 (63.2, 264) μg/mL, compared with mild to moderate EV group [352.4 (167.0, 627.8) μg/mL, 140.2 (69.8, 188.5) μg/mL, 16.2 (7.3, 33.5) μg/mL and 153.2 (84.8, 229.9) μg/mL, severe EV group [640.2 (290.2, 918.7) μg/mL, 158.7 (94.6, 236.4) μg/mL, 19.6 (9.5, 47.5) μg/mL and 180.7 (119.0, 282.6) μg/mL], the differences were statistically significant (P<0.05). SD of no EV group, mild to moderate EV group and severe EV group were 13.2 (10.8, 15.0) cm, 14.4 (11.4, 16.0) cm and 15.8 (14.6, 17.2) cm, the difference was statistically significant (P<0.05). The scores of LSM and LSP in EV group were 14.8 (10.6, 24.0) kPa and 1.9 (1.0, 3.5) points, compared with mild to moderate EV group [24.7 (17.8, 29.5) kPa and 4.6 (2.4, 7.2) points] and severe EV group [37.2 (28.8, 42.6) kPa and 10.0 (6.2, 14.2) points], respectively, the differences were statistically significant (P<0.05). The correlation between the above indexes of liver fibrosis and EV degree was analyzed. The results showed that SD, LSM and LSPS were moderately positively correlated with EV degree (r=0.51, 0.63 and 0.67, P<0.05), while HA, LN, PIIINP and CIV were weakly positively correlated with EV degree (r=0.25, 0.28, 0.21 and 0.23, P<0.05), however, PLT was negatively correlated with EV (r=-0.41, P<0.05). Evaluation of diagnostic efficacy of various indexes of liver fibrosis for EV showed that the diagnostic AUC values of PLT, HA, LN, PIIINP, CIV, SD, LSM and LSP scores were 0.77, 0.65, 0.64, 0.61, 0.59, 0.77, 0.84 and 0.87, respectively. Evaluate the diagnostic efficacy of various liver fibrosis indexes for severe EV. As shown in Table 3, the diagnostic AUC values of PLT, HA, LN, PIIINP, CIV, SD, LSM and LSP scores are 0.71, 0.64, 0.59, 0.62, 0.60, 0.77, 0.84 and 0.86, respectively.Conclusion PLT, HA, LN, PIIINP, CIV, SD, LSM and LSP scores were correlated with EV status in patients with HBV related cirrhosis, among which LSP score had better diagnostic efficacy for the presence of EV and severe EV, and had guiding significance for the treatment of patients with HBV related cirrhosis.

Key words: Chronic hepatitis B, Cirrhosis, Esophageal varices, Liver stiffness measurement, Spleen diameter

刘成帅, 吴现泉, 张璞, 宋坤. 基于肝硬度值、脾脏直径和血小板的LSP评分对乙型肝炎肝硬化食管静脉曲张的评价[J]. 肝脏, 2023, 28(12): 1426-1425.

LIU Cheng-shuai, WU Xian-quan, ZHANG Pu, SONG Kun. Preliminary evaluation of esophageal varices in patients with hepatitis B related cirrhosis by LSP score based on liver stiffness measurement, spleen diameter and platelets[J]. Chinese Hepatolgy, 2023, 28(12): 1426-1425.

参考文献

[1] Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology, 2017, 65(1):310-335.
[2] 盛基尧, 刘水, 杨永生, 等. 肝硬化门静脉高压症食管胃静脉曲张出血诊疗进展.中华外科杂志, 2020, 58(10):808-812.
[3] 中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版).中华外科杂志, 2019, 57(12):885-892.
[4] Tsuji Y, Namisaki T, Kaji K, et al. Comparison of serum fibrosis biomarkers for diagnosing significant liver fibrosis in patients with chronic hepatitis B. Exp Ther Med, 2020, 20(2):985-995.
[5] Dong H, Xu C, Zhou W, et al. The combination of 5 serum markers compared to FibroScan to predict significant liver fibrosis in patients with chronic hepatitis B virus. Clin Chim Acta, 2018, 483:145-150.
[6] Liao Y, Gong J, Zhou W, et al. Serum liver fibrosis markers discriminate significant liver inflammation in chronic hepatitis B patients with normal or near-normal alanine aminotransferase. J Med Virol, 2019, 91(4):642-649.
[7] Stefano JT, Guedes LV, de Souza AAA, et al. Usefulness of collagen type IV in the detection of significant liver fibrosis in nonalcoholic fatty liver disease. Ann Hepatol, 2021, 20:100253.
[8] Yu XY, Song XX, Tong YL, et al. Usefulness of controlled attenuation parameter and liver stiffness measurement for detecting increased arterial stiffness in asymptomatic populations in China. Medicine (Baltimore), 2020, 99(48):e23360.
[9] Qu Y, Song YY, Chen CW, et al. Diagnostic performance of FibroTouch ultrasound attenuation parameter and liver stiffness measurement in assessing hepatic steatosis and fibrosis in patients with nonalcoholic fatty liver disease. Clin Transl Gastroenterol, 2021, 12(4):e00323.
[10] 中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版). 中国肝脏病杂志(电子版), 2019, 11(4): 5-27.
[11] 中华医学会消化内镜学分会. 食管胃静脉曲张内镜下诊断和治疗规范试行方案(2003年). 中华消化内镜杂志, 2004, (3):149-151.
[12] Boregowda U, Umapathy C, Halim N, et al. Update on the management of gastrointestinalvarices. World J Gastrointest Pharmacol Ther, 2019, 10(1):1-21.
[13] Merli M, Nicolini G, Angeloni S, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol, 2003, 38(3):266-272.
[14] McDonald SA, Barclay ST, Hutchinson SJ, et al. Uptake of endoscopic screening for gastroesophageal varices and factors associated with variceal bleeding in patients with chronic hepatitis C infection and compensated cirrhosis, 2005-2016: a national database linkage study. Aliment Pharmacol Ther, 2019, 50(4):425-434.
[15] 中国肝炎防治基金会, 中华医学会感染病学分会, 中华医学会肝病学分会和中国研究型医院学会肝病专业委员会. 瞬时弹性成像技术诊断肝纤维化专家共识(2018年更新版). 中华肝脏病杂志, 2019, 27(3):182-191.
[16] 王洁, 黄杰安. 无创指标预测食管胃底静脉曲张破裂出血风险的研究进展. 中华胃肠内镜电子杂志, 2016, 3(3):121-124.