脾脏硬度与接受抗病毒治疗乙肝肝硬化患者食管胃底静脉曲张的关系  

Analysis of associations between spleen stiffness and esophageal-gastric varices in patients with HBVrelated liver cirrhosis receiving anti-viral treatment

作　　者：施海燕[1] 许敏[1] 邓浩辉[1] 陈铿[1] 高洪波[1] 张舒眉[1] 廖宝林[1] 

机构地区：[1]广州市第八人民医院肝病科,510060

出　　处：《实用医学杂志》2015年第7期1057-1060,共4页The Journal of Practical Medicine

基　　金：广东省科技厅科技计划项目

摘　　要：目的:探讨应用瞬时弹性扫描仪(Fibro Scan,FS)检测脾脏硬度对接受抗病毒治疗乙肝肝硬化患者食管胃底静脉曲张(esophageal varices,EV)的诊断价值。方法:2014年1-12月我院肝病科门诊或住院接受抗病毒治疗乙肝肝硬化患者41例纳入本项研究。使用FS测量脾脏及肝脏弹性值,同时进行胃镜检查。以胃镜检查结果为金标准计算脾脏FS值与肝脏FS值的受试者工作特征曲线下面积(area under receiver operating characteristic curve,AUROC),评价其对EV及其程度的预测价值。结果:脾脏FS值为(40.64±25.45)k Pa,肝脏FS值为(20.76±13.21)k Pa,脾脏FS值与肝脏FS值呈正相关(r=0.402,P<0.001)。无EV患者的脾脏FS值较伴轻度以及中-重度EV患者的显著下降(均P<0.05),且轻度EV组较中-重度EV组的显著下降(P<0.05)。脾脏FS值预测EV的AUROC为0.863,灵敏度为79.4%,特异度为83.2%,预测中-重度EV的AUROC为0.924,灵敏度为87.9%,特异度为91.3%,均较肝脏FS值明显升高。结论:脾脏FS值可作为预测接受抗病毒治疗乙肝肝硬化患者EV及其程度的无创性指标。Objective To investigate the diagnosis value of spleen stiffness measurement by transient elastography （FibroScan, FS） for esophageal-gastric varices （EV） in patients with HBV-related liver cirrhosis receiving anti-viral treatment. Method Total of 41 patients from Jan 2014 to Dec 2014 diagnosed with HBV- related liver cirrhosis receiving anti-viral treatment were enrolled. All patients were evaluated for spleen and liver stiffness measurement by FS and checked by gastroscopy for diagnosis of EV. Using gastroscopy as the gold standard, the area under receiver operating characteristic curve （AUROC） were used to evaluate the value of the spleen stiffness and liver stiffness in diagnosis of EV and its degree. Results The spleen and liver FS values in patients were （40.64 ＋ 25.45） kPa and （20.76 ~ 13.21） kPa respectively, and they showed a positive correlation （r = 0.402, P 〈 0.001）. The spleen FS values in patients without EV were significantly lower than those in patients with mild EV and moderate-severe EV （all P 〈 0.05）. Furthermore, they showed significantly lower in patients with mild EV than those in patients with moderate-severe EV too （P 〈 0.05）. The AUROC of spleen FS in patients with EV was 0.863, with sensitivity of 79.4% and specificity of 83.2%. Moreover, the AUROC of spleen FS in patients with moderate-severe EV was 0.924, with sensitivity of 87.9% and specificity of 91.3%. Both of them were much higher than those of liver FS. Conclusion Spleen FS may act as a non- invasive marker to predict EV and its degree in patients with HBV-related liver cirrhosis receiving anti-viral treatment.

关 键 词：肝硬化 乙肝肝硬化 静脉曲张 肝脏硬度 脾脏硬度 

分 类 号：R575.2[医药卫生—消化系统]