非侵入性肝纤维化评分在肝硬化并食管胃底静脉曲张严重程度预测中的运用

摘要/Abstract

摘要： 目的评估无创检查预测食管静脉曲张严重程度及出血的可能性。方法收集2021年1月至2022年5月包头医学院第二附属医院86例肝病患者的临床资料,包括实验室检查、影像学检查、胃镜检查。根据胃镜检查评估食管静脉曲张严重程度。APRI、GPR、FIB-4、S-index、AAR、GAPRI对肝硬化伴食管静脉曲张出血严重程度的预测价值。结果 APRI、GPR、FIB-4、S-index、AAR、GAPRI评估肝硬化食管胃底静脉曲张出血严重程度的曲线下面积分别为0.646、0.637、0.634、0.632、0.566、0.636,特异度分别56.72%、89.74%、36.84%、73.68%,57.89%、89.47%,敏感度分别为56.72%、40.30%、91.04%、55.22%、61.19%、40.30%。食管静脉曲张轻度组中血小板、ALT、RDW分别为(114.47±50.71)×10⁹、(34.74±15.81)U/L、(16.889±2.252),严重组为(95.79±42.27)×10⁹、(42.52±24.97)U/L、(15.849±2.602),差异均无统计学意义(P>0.05)。轻度组APRI 、FIB-4 、S-index、 GAPRI、 GPR 、AAR分别为0.637(0.409,0.895)、0.637(0.409,0.895)、3.562(2.166,6.155)、0.435(0.211,0.984)、43.810(26.829,64.021)、0.730(0.447,1.067)、1.555±0.623,严重组分别为 0.901(0.524,1.407)、0.901(0.524,1.407)、4.5(3.335,6.991) 、0.891(0.327,1.778) 61.000(29.126,144.444)、1.017(0.485,2.407)、1.482±0.720,差异无统计学意义(P>0.05)。结论 APRI、GPR、GAPRI、S-index对肝硬化伴食管静脉曲张出血严重程度有一定预测价值,其中APRI预测价值更大。

关键词: 肝硬化, 食管胃底静脉曲张破裂出血, APRI, GPR, FIB-4, S-index, AAR, GAPRI , 预测

Abstract: Objective Esophageal variceal bleeding is a complication in patients with portal . The aim of the study was to investigate the clinical value of noninvasive model in predicting the severity of esophageal and gastric varices in patients with cirrhosis. Methods The clinical data of 86 patients admitted to our hospital from May 2020 to January 2021 were collected, including laboratory examination, imaging and gastroscopy results. The severity of esophageal varices was evaluated according to gastroscopy. The predictive value of noninvasive liver fiber scores including aspartate aminotransferase/platelet ratio index (APRI), r-gamma-glutamyl transpeptidase-to-platelet ratio (GPR), fibrosis index based on the four factors (FIB-4), S-index, aspartate transaminase-to-alanine transaminase ratio (AAR) and gamma-glutamyl 1 transpeptitiase-platelet ratio (GAPRI) were compared, and the receiver operator characteristic (ROC) curve conducted. Results The area under the ROC curve of APRI, GPR, FIB-4, S-index, AAR, GAPRI were 0.646, 0.637, 0.634, 0.632, 0.566, 0.636 respectively, and the diagnostic value of APRI was the highest. The specificity of APRI, GPR, FIB-4, S-index, AAR, GAPRI were 56.72%, 89.47%, 36.84%, 73.68%, 57.89%, 89.47%, the specificity of GPR and APRI was the highest. The sensitivity of APRI, GPR, FIB-4, S-index, AAR, GAPRI were 56.72%, 40.30%, 91.04%, 55.22%, 61.19%, 40.30% respectively, sensitivity of APRI was the highest. Platelets, alanine transaminase (ALT), and RDW in mild esophageal varices group were 114.47 ± 50.715, 34.74 ± 15.818, 16.889 ± 2.2521, respectively, while those in severe esophageal varices group were 95.79 ± 42.272, 42.52 ± 24.971, 15.849 ± 2.6023, there was no statistical difference between the two groups (P>0.05). There was no significant difference of APRI, FIB-4, S-index, GAPRI, GPR, and AAR between mild esophageal varices group and severe group [0.637 (0.409, 0.895), 0.637 (0.409, 0.895), 3.562 (2.166, 6.155), 0.435 (0.211, 0.984), and 43.81 (26.829, 64)] vs [901 (0.524,1.407), 0.901 (0.524,1.407), 4.5 (3.335,6.991), 0.891 (0.327,1.778) 61 (29.126144.444), 1.017 (0.485,2.407), 1.48251 ± 0.720318], (P>0.05). Conclusion APRI, GPR, GAPRI and S-index may have a certain predictive value for the severity of esophageal variceal hemorrhage in patients with liver cirrhosis, and the predictive value APRI maybe higher.

Key words: Liver cirrhosis, Esophageal and gastric variceal bleeding, Aspartate aminotransferase/platelet ratio index, R-gamma-glutamyl transpeptidase-to-platelet ratio, Fibrosis index based on the four factors, S-index, Aspartate transaminase-to-alanine transaminase ratio, Gamma-glutamyl 1 transpeptitiase-platelet ratio, Prediction

李文婷, 党彤, 王晶, 王海英. 非侵入性肝纤维化评分在肝硬化并食管胃底静脉曲张严重程度预测中的运用[J]. 肝脏, 2023, 28(2): 171-174.

LI Wen-ting, DANG Tong, WANG Jing, WANG Hai-ying. Application of noninvasive liver fibrosis score in predicting the severity of esophageal and gastric varices in patients with cirrhosis[J]. Chinese Hepatolgy, 2023, 28(2): 171-174.

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