肝硬化患者APRI与门静脉压力的相关性分析  

Analysis of the correlation between APRI and portal vein pressure in patients with liver cirrhosis

作　　者：左晨艳 孙连芹 刘澄 杨威 程文芳[2] ZUO Chen-yan;SUN Lian-qin;LIU Cheng;YANG Wei;CHENG Wen-fang(Department of Gastroenterology,Lianyungang First People′s Hospital,Jiangsu 222006,China;Department of Gastroenterology,the First Affiliated Hospital with Nanjing Medical University,Jiangsu 210029,China)

机构地区：[1]连云港市第一人民医院消化内科,江苏222006 [2]南京医科大学第一附属医院消化内科

出　　处：《肝脏》2021年第1期41-43,50,共4页Chinese Hepatology

基　　金：江苏省教育厅自然科学基金(15KJB320001)。

摘　　要：目的通过评估天冬氨酸氨基转移酶/血小板比值指数(APRI)与门静脉压力(PVP)在肝硬化患者中的相关性,探索APRI对门脉高压的无创诊断价值。方法选取2015年8月至2019年6月于南京医科大学第一附属医院介入科行经颈静脉肝内门体静脉分流术(TIPS)介入治疗的54名肝硬化门脉高压患者为研究对象,分别测定其APRI和PVP水平。结果本研究包括54名患者,中位年龄56岁(范围26~74岁),男性占64.8%。肝硬化的病因中,病毒性30例(55.6%),酒精性3例(5.6%),隐源性和其他21例(38.9%)。PVP中位数为40 cmH_(2)O(范围16~61 cmH_(2)O)。APRI中位数为1.255(范围0.08~4.72)。APRI与PVP显著正相关(Spearman相关系数r=0.356;P=0.008)。APRI预测门脉高压(PVP>30 cmH_(2)O)的受试者操作特征曲线下面积(AUROC)为0.881(P=0.001,95%置信区间:0.756~1.000)。APRI≥0.81在预测PVP>30 cmH_(2)O时的敏感度为78.7%,特异性为85.7%,阳性预测值为97.4%,阴性预测值为37.5%,诊断准确率为79.6%。结论在肝硬化患者中,APRI与PVP之间呈正相关。APRI≥0.81对预测门脉高压具有可接受的准确性,可作为门脉高压无创诊断的血清标志物。Objective To evaluate the correlation between aspartate aminotransferase to platelet ratio index(APRI and portal vein pressure(PVP)in patients with liver cirrhosis,and to investigate the diagnostic value of APRI for portal hypertension.Methods The patients with cirrhosis and portal hypertension who underwent transjugular intrahepatic portosystemic shunt(TIPS)in the Department of Intervention in our hospital from August 2015 to June 2019 were selected,and their APRI and PVP were measured.Results There were 54 patients enrolled in the study,with an median age of 56 years(range 26-74 years),and 64.8% of them were males.The etiology of cirrhosis was virus in 30(55.6%),alcohol in3(5.6%),and others in 21(38.9%).The median of PVP was 40 cmH_(2)O(range 16-61 cmH_(2)O).The median of APRI was 1.255(range 0.08-4.72).There was significant positive correlation between PVP and APRI(Spearman’s rho=0.356,P=0.008).Area under the receiver operating characteristic curve of APRI for predicting high portal pressure(PVP>30 cmH_(2)O)was 0.881(P=0.001,95%confidence interval:0.756-1.000).APRI≥ 0.81 was 78.7% sensitive and 85.7%specific in predicting PVP>30 cmH_(2)O,with positive predictive value of 97.4%,negative predictive value of 37.5%,and diagnostic accuracy of 79.6%.Conclusion APRI correlates positively with PVP in patients of liver cirrhosis.APRI≥0.81 has an acceptable accuracy for the prediction of high portal pressure and APRI can be used as a serum marker for noninvasive diagnosis of portal hypertension.

关 键 词：肝硬化 门脉高压 天冬氨酸氨基转移酶/血小板比值指数 门静脉压力 无创 

分 类 号：R575.2[医药卫生—消化系统]