肝脾硬度联合血清腺苷脱氨酶对乙型肝炎肝硬化重度食管静脉曲张的预测价值分析  

Value of liver/spleen stiffness combined with serum adenosine deaminase in predicting severe esophageal varices in patients with hepatitis B cirrhosis

作　　者：谢青 李曾 唐臻 李金强 刘凤娥 XIE Qing;LI Zeng;TANG Zhen;LI Jinqiang;LIU Feng′e(Department of Infectious Diseases, Changsha First Hospital, Changsha 410000, China)

机构地区：[1]长沙市第一医院感染科,长沙410000

出　　处：《临床肝胆病杂志》2021年第6期1314-1318,共5页Journal of Clinical Hepatology

基　　金：湖南省卫生健康委科研计划项目(20200163)。

摘　　要：目的评价FibroTouch(FT)瞬时弹性成像技术测量肝脾硬度及其联合血清腺苷脱氨酶(ADA)对乙型肝炎肝硬化患者重度食管静脉曲张(EV)的预判价值。方法选取2017年12月—2020年6月在长沙市第一医院感染科就诊的120例乙型肝炎肝硬化患者的临床资料,FT测量肝脏硬度值(LSM)和脾脏硬度值(SSM),完善电子胃镜、血清ADA、Hb、PLT、Alb、ALT及AST检查,计算血清肝纤维化指标APRI、AAR及FIB-4。将研究对象根据胃镜下EV程度,分为重度EV组(n=58)和非重度(无或轻中度)EV组(n=62)。满足正态分布的计量资料2组间比较采用t检验,非正态性的计量资料2组间比较采用Mann-Whitney U检验,计数资料2组间比较采用χ2检验。采用Spearman秩相关检验分析LSM、SSM、ADA与重度EV的关系。采用受试者工作特征曲线(ROC曲线)分析LSM、SSM、ADA诊断重度EV的效能,计算敏感度及特异度,行二分类变量logistic回归,计算联合指标的ROC曲线下面积(AUC),AUC比较应用Z检验。结果LSM、SSM与ADA在2组间比较差异均有统计学意义(P值均<0.05)。LSM、SSM、ADA与重度EV之间均存在显著正相关,相关系数分别为0.686、0.743和0.723(P值均<0.05)。LSM、SSM、ADA预判重度EV的最佳阈值分别为22.35 kPa、45.25 kPa和34.50 U/L,AUC分别为0.746、0.802和0.791,灵敏度分别为82.8%、75.9%和58.6%,特异度分别为65.6%、77.4%和90.2%。LSM+ADA、SSM+ADA、LSM+SSM+ADA联合预判重度EV的AUC分别为0.826、0.853和0.907(P值均<0.05)。结论肝脾硬度联合血清ADA对重度EV具有较好的预判价值,能够为临床上拒绝行胃镜检查患者预测重度EV提供初步诊断依据。Objective To investigate the value of liver stiffness measurement(LSM)and spleen stiffness measurement(SSM)based on FibroTouch(FT)transient elastography combined with serum adenosine deaminase(ADA)in predicting severe esophageal varices(EV)in patients with hepatitis B cirrhosis.Methods Related clinical data were collected from 120 patients with hepatitis B cirrhosis who attended Department of Infectious Diseases,Changsha First Hospital,from December 2017 to June 2020.FT was used to measure LSM and SSM,and related examinations were performed,including electronic gastroscopy and serum levels of ADA,hemoglobin,albumin,alanine aminotransferase,and aspartate aminotransferase and platelet count.The serum liver fibrosis markers aspartate aminotransferase-to-platelet ratio index(APRI),aspartate aminotransferase/alanine aminotransferase ratio(AAR),and fibrosis-4(FIB-4)were calculated.According to the severity of EV under gastroscopy,the subjects were divided into severe EV group with 58 patients and non-severe EV(without EV or with mild-to-moderate EV)group with 62 patients.The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups;the chi-square test was used for comparison of categorical data between groups.The Spearman rank correlation test was used to investigate the correlation of LSM,SSM,and ADA with severe EV.The receiver operating characteristic(ROC)curve was used to analyze the efficacy of LSM,SSM,and ADA in the diagnosis of severe EV,and sensitivity and specificity were calculated.A multivariate binary logistic regression analysis was performed to calculate the area under the ROC curve(AUC)of the combined indicators,and the Z test was used for comparison of AUC.Results There were significant differences in LSM,SSM,and ADA between the two groups(all P<0.05).LSM,SSM,and ADA were positively correlated with severe EV,with a correlation coefficient of 0.686,0.743,and 0.723,resp

关 键 词：乙型肝炎 肝硬化 食管和胃静脉曲张 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]