肝脏硬度-脾脏直径/血小板比率等无创诊断指标对肝硬化高危食管静脉曲张的预测价值

肝脏 ›› 2025, Vol. 30 ›› Issue (3): 310-315.

肝脏硬度-脾脏直径/血小板比率等无创诊断指标对肝硬化高危食管静脉曲张的预测价值

孙微, 余虹, 牛丽娜, 隆强, 窦靖, 刘云霄, 郭峰, 王晓忠

830000 乌鲁木齐新疆医科大学第四临床医学院(孙微,余虹,牛丽娜,隆强,窦靖,刘云霄);新疆维吾尔自治区中医医院(郭峰,王晓忠)

收稿日期:2024-02-15 出版日期:2025-03-31 发布日期:2025-06-16
通讯作者: 王晓忠,Email: wzx125@sina.com
基金资助:
新疆维吾尔自治区中医药研究院(2022D01C173);新疆医科大学研究生创新创业项目(CXCY2022026);乐德行全国名医工作室

The diagnostic value of non-invasive diagnostic indicators such as liver hardness-spleen diameter/platelet ratio (LSPS) for predicting high-risk oesophageal varicose veins (HERV) in liver cirrhotic patients

SUN Wei¹, YU Hong¹, NIU Li-na¹, LONG Qiang¹, DOU Jing¹, LIU Yun-xiao¹, GUO Feng², WANG Xiao-zhong²

1. The Fourth Clinical Medical College of Xinjiang Medical University, Urumqi, Urumqi 830000, China;
2. Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, China

Received:2024-02-15 Online:2025-03-31 Published:2025-06-16
Contact: WANG Xiao-zhong,Email:wzx125@sina.com

摘要/Abstract

摘要： 目的评估肝脏硬度×脾脏直径/血小板比率(LSPS)等无创诊断指标对肝硬化高危食管静脉曲张(HERV)的预测价值。方法纳入2021年12月至2023年6月新疆医科大学附属中医医院住院的肝硬化患者143例。采集临床资料和血清学指标,同时进行电子胃镜、腹部超声及肝脏瞬时弹性成像检测,以胃镜为金标准,将患者分为高危静脉曲张组和非高危静脉曲张组。计算LSPS、静脉曲张风险评分、PH评分、FIB-4、APRI及GPR。以受试者工作特征曲线下面积(AUC)评价各无创模型对HERV的诊断效能。结果 143例患者中,高危静脉曲张患者63例,非高危静脉曲张患者80例。与非高危静脉曲张组相比,高危静脉曲张组患者的血清学指标、影像学指标(门静脉直径、脾厚度、脾长径)、肝功能评分(CTP、MELD)、无创诊断指标(LSPS、PH评分、静脉曲张风险评分、LSM、FIB-4、APRI及GPR),差异均有统计学意义(均P<0.05)。无创诊断指标中诊断HERV的AUC由高到低依次为LSPS:0.865(95%CI:0.806～0.923)、PH评分:0.856(95%CI:0.796～0.917)、静脉曲张风险评分:0.855(95%CI:0.795～0.916)、FIB-4:0.817(95%CI:0.744～0.890)、APRI:0.766(95%CI:0.686～0.846)、CTP评分:0.761(95%CI:0.680～0.843)、LSM:0.740(95%CI:0.660～0.821)、MELD评分:0.693(95%CI:0.607～0.780)及GPR:0.667(95%CI:0.575～0.758)。无创诊断联合指标与单独指标比较,对HERV的诊断效能并未显著提高。结论 LSPS对HERV具有较好的诊断价值,优于其他单独无创诊断指标及联合模型。

关键词: 肝脏硬度-脾脏直径/血小板比率, 无创诊断指标, 肝硬化高危食管静脉曲张, 诊断价值

Abstract: Objective To evaluate the diagnostic value of non-invasive diagnostic indicators such as liver hardness-spleen diameter/platelet ratio (LSPS) in predicting patients with high-risk oesophageal varicose veins (HERV) in liver cirrhosis.Methods A total of 143 patients with liver cirrhosis who were hospitalized in the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University from March 2022 to March 2023 were enrolled in this study. Their clinical data and serological indicators were collected. Electronic gastroscopy, abdominal ultrasound and liver instantaneous elastic imaging (LSM) were conducted at the same time in all patients. Taking gastroscopy as the gold standard, the patients are divided into a high-risk varicose and a non-high-risk varicose groups. LSPS, varicose risk score, PH score, FIB-4, APRI and GPR were calculated, and the working characteristics (ROC) curve of the subjects were drawn to evaluate the efficacy of these non-invasive models for the diagnosis of HERV.Results (1) Within the 143 cases included in this study, 63 patients had high-risk varicose veins and 80 patients had non-high-risk varicose veins. (2) When compared with the non-high-risk varicose veins group, the serological indicators, imaging indicators (portal vein diameter, spleen thicknes, spleen length) and liver function scores (CTP, MELD), the non-invasive diagnostic indicators such as LSPS, PH score, risk score of varicose veins, LSM, FIB-4, APRI and GPR of patients in the high-risk varicose group were significantly different (P<0.05). (3) The area under the curve (AUC) for the non-invasive diagnostic index is LSPS: 0.865 (95%CI 0.806～0.923), PH score: 0.856 (95%CI 0.796～0.917), static pulse risk score: 0.855 (95%CI 0.795～0.916), FIB-4:0.817 (95%CI 0.744～0.890), APRI: 0.766 (95%CI 0.686～0.846), CTP score: 0.761 (95%CI 0.680～0.843), LSM: 0.740 (95%CI 0.660～0.821), MELD score: 0.693 (95%CI 0.607～0.780) and GPR: 0.667 (95%CI 0.575～0.758). (4) Compared with the joint index of non-invasive diagnosis and the individual index, the diagnostic efficacy of HERV was not significantly improved.Conclusion LSPS has good diagnostic value for HERV, which is better than other individual non-invasive diagnostic indicators and joint models.

Key words: Liver hardness-spleen diameter/platelet ratio, Non-invasive diagnostic indicators, High-risk oesophageal varicose veins of liver cirrhosis, Diagnostic value

孙微, 余虹, 牛丽娜, 隆强, 窦靖, 刘云霄, 郭峰, 王晓忠. 肝脏硬度-脾脏直径/血小板比率等无创诊断指标对肝硬化高危食管静脉曲张的预测价值[J]. 肝脏, 2025, 30(3): 310-315.

SUN Wei, YU Hong, NIU Li-na, LONG Qiang, DOU Jing, LIU Yun-xiao, GUO Feng, WANG Xiao-zhong. The diagnostic value of non-invasive diagnostic indicators such as liver hardness-spleen diameter/platelet ratio (LSPS) for predicting high-risk oesophageal varicose veins (HERV) in liver cirrhotic patients[J]. Chinese Hepatolgy, 2025, 30(3): 310-315.

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