胃左静脉分流指数、脾硬度值和GPR对肝硬化患者发生高风险食管胃底静脉曲张的评估效能

摘要/Abstract

摘要： 目的分析胃左静脉分流指数(LGVSI)、脾硬度值(SSM)和γ-谷氨酰转肽酶与血小板比率(GPR)对肝硬化发生食管胃底静脉曲张(EGV)的临床预测效能。方法选择2022年1月至2024年12月诊治的肝硬化合并EGV患者115例,根据电子胃镜检查结果分为轻度曲张组30例、中度曲张组48例和重度曲张组37例,非EGVB组68例和EGVB组47例。比较各组的LGVSI、SSM和GPR,应用Pearson相关性分析评估LGVSI、SSM和GPR与ALBI、FIB-4指数和Child-Pugh分级的相关性;绘制受试者工作特征曲线分析LGVSI、SSM和GPR联合检测评估EGV的效能。结果重度EGV组的LGVSI、SSM和GPR为0.43、23.29 kPa和1.28分,高于中度组的0.32、21.06 kPa和0.69分,以及轻度组的0.21、17.54 kPa和0.45分,差异均有统计学意义(H=11.439、F=9.185、H=15.627,均P<0.05)。EGVB组LGVSI、SSM、GPR、ALBI、FIB-4、Child-Pugh评分为0.47、24.72 kPa、1.37分、-1.15、5.94和2.06,高于非EGVB组的0.28、19.36 kPa、0.61、-1.41、4.51和2.43,差异均有统计学意义(Z=7.416、t=7.639、Z=8.264、Z=7.529、t=9.162和Z=7.284,均P<0.05)。Pearson分析显示,肝硬化发生EGV患者LGVSI、SSM和GPR评分与ALBI、FIB-4指数和Child-Pugh分级评分呈正相关(P<0.01)。ROC曲线显示,LGVSI、SSM和GPR三者联合评估肝硬化患者发生EGV的AUC、灵敏度和特异度均高于任一单项效能(P<0.01)。结论 LGVSI、SSM联合GPR评分联合检测能有效反映肝硬化患者和EGVB风险,具有较高的临床价值。

关键词: 肝硬化, 高风险食管静脉曲张, 实时剪切波弹性成像, 诊断效能

Abstract: Objective To analyze the clinical predictive efficacy of the left gastric vein shunt index (LGVSI), spleen stiffness value (SSM), and gamma-glutamyl transpeptidase to platelet ratio (GPR) for the occurrence of high-risk esophageal varices (EGV) in patients with liver cirrhosis (LC). Methods A total of 115 patients with LC combined with EGV who were diagnosed and treated from January 2022 to December 2024 were selected. According to the results of electronic gastroscopy, they were divided into a mild variceal group (n=30), a moderate variceal group (n=48), and a severe variceal group (n=37). Additionally, 68 cases were in the non-EGV group and 47 cases were in the EGV group. The LGVSI, SSM, and GPR scores of each group were detected and compared. Pearson analysis was conducted to explore the correlations between LGVSI, SSM, GPR scores and albumin-bilirubin score (ALBI), FIB-4 index, and Child-Pugh modified grading scores. The receiver operating characteristic curve (ROC) was drawn to analyze the efficacy of combined detection of LGVSI, SSM, and GPR in evaluating EGV. Results The LGVSI, SSM and GPR scores in the severe EGV subgroup were 0.43, 23.29 kPa and 1.28 respectively, which were higher than those of 0.32, 21.06 kPa and 0.69 in the moderate subgroup and 0.21, 17.54 kPa and 0.45 in the mild subgroup, the differences were statistically significant (H=11.439, F=9.185, H=15.627, all P<0.05). The LGVSI, SSM, GPR, ALBI, FIB-4 and Child-Pugh scores in the EGVB subgroup were 0.47, 24.72 kPa, 1.37, -1.15, 5.94 and 2.06 respectively, which were higher than those of 0.28, 19.36 kPa, 0.61, -1.41, 4.51 and 2.43 in the non-EGVB subgroup, and the differences were also statistically significant (Z=7.416, t=7.639, Z=8.264, Z=7.529, t=9.162 and Z=7.284, all P<0.05). Pearson analysis showed that the LGVSI, SSM and GPR scores of patients with HREV in LC were positively correlated with the ALBI, FIB-4 index and Child-Pugh modified grading scores (P<0.01). The ROC curve showed that the AUC, sensitivity and specificity of the combined assessment of LGVSI, SSM and GPR for the occurrence of HREV in LC patients were higher than the efficacy of any single item (P<0.01). Conclusion The combined detection of LGVSI, SSM and GPR score can effectively reflect the degree of liver fibrosis and the bleeding risk of EGV in LC patients, which has high clinical diagnosis efficacy.

Key words: Liver cirrhosis, High-risk esophageal varices, Real-time shear wave elastography, Diagnostic efficacy

朱红梅, 仲跻凤, 黄勇. 胃左静脉分流指数、脾硬度值和GPR对肝硬化患者发生高风险食管胃底静脉曲张的评估效能[J]. 肝脏, 2026, 31(3): 356-360.

ZHU Hong-mei, ZHONG Ji-feng, HUANG Yong. The efficacy of left gastric vein shunt index, spleen stiffness value and GPR in the assessment of high-risk esophageal varices in cirrhotic patients[J]. Chinese Hepatolgy, 2026, 31(3): 356-360.

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