机构地区:[1]中国医科大学附属第一医院传染科,沈阳110000 [2]中国医科大学附属第一医院临床流行病教研室,沈阳110000 [3]中国医科大学附属第一医院超声科,沈阳110000 [4]浙江大学医学院附属第四医院感染科,浙江义乌322000
出 处:《临床肝胆病杂志》2021年第7期1572-1577,共6页Journal of Clinical Hepatology
基 金:国家“十三五”科技重大专项(2017ZX10103007-005)。
摘 要:目的建立乙型肝炎肝硬化患者中重度食管胃静脉曲张(GEV)的无创性诊断模型。方法选取2017年10月—2019年12月于中国医科大学附属第一医院就诊的乙型肝炎肝硬化患者。以胃镜检查结果为金标准,分为无/轻度GEV组和中重度GEV组。不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验;计数资料两组间比较采用χ^(2)检验。采用logistic回归分析乙型肝炎肝硬化患者中重度食管胃静脉发生与二维剪切波弹性成像(2D-SWE)测量脾硬度、PLT/脾直径之间的关系,以后退法作为自变量筛选方法,建立回归方程即诊断模型并进行检验。绘制受试者工作特征曲线(ROC曲线)判断肝和脾硬度、PLT/脾直径以及诊断模型等无创性检查指标的诊断价值,得出最佳截断值,DeLong检验比较几种无创性检查指标的ROC曲线之间是否具有统计学意义。结果共纳入168例乙型肝炎肝硬化患者,其中有67例诊断为中重度GEV。肝硬化无/轻度和中重度GEV组PLT、ALT、Alb、WBC以及INR比较差异均有统计学意义(Z值分别为-6.508、-2.132、-2.470、-4.510、-5.298,P值均<0.05)。2D-SWE测量的脾硬度、脾脏直径以及PLT/脾脏直径在两组间差异均有统计学意义(Z值分别为-7.264、-5.924、-7.028,P值均<0.05)。PLT/脾直径ROC曲线下面积(AUC)为0.821(95%CI:0.754-0.875),截断值为≤6.7,敏感度为83.58%,特异度为74.26%。脾硬度AUC为0.831(95%CI:0.766-0.885),脾硬度截断值≥34.2 kPa,敏感度为85.07%,特异度为73.27%。肝硬度AUC为0.557(95%CI:0.479-0.634),肝硬度的截断值≥10.8 kPa,特异度为79.10%,敏感度为40.59%。肝硬度与脾硬度、PLT/脾直径对GEV诊断价值的AUC比较,差异均有统计学意义(Z值分别为4.878、5.536,P值均<0.001)。建立判断乙型肝炎肝硬化患者中重度GEV模型:Y=-0.682+0.068×脾硬度-0.225(PLT/脾直径)。诊断模型AUC为0.860(95%CI:0.799-0.909),敏感度为79.10%,特异度为81.19%,准确度为79.1%。结�Objective To establish a noninvasive diagnostic model for moderate-to-severe gastroesophageal varices( GEV) in patients with hepatitis B cirrhosis. Methods The patients with hepatitis B cirrhosis who attended The First Affiliated Hospital of China Medical University from October 2017 to December 2019 were enrolled,and with the results of gastroscopy as the gold standard,the patients were divided into none-to-mild GEV group and moderate-to-severe GEV group. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups,and the chi-square test was used for comparison of categorical data. A logistic regression analysis was used to investigate the association of moderate-to-severe GEV with spleen stiffness measured by two-dimensional shear wave elastography( 2D-SWE) and platelet count( PLT)/spleen diameter ratio in patients with hepatitis B cirrhosis,and with the backward method for independent variable screening,a regression equation,i. e.,a diagnostic model,was established and validated. The receiver operating characteristic( ROC) curve was plotted to investigate the diagnostic value of noninvasive examination indices including liver and spleen stiffness,PLT/spleen diameter ratio,and the above diagnostic model and obtain their cut-off values,the DeLong test was used to compare whether there is a statistical significance between the ROC curves of the above noninvasive indices. Results A total of 168 patients with hepatitis B cirrhosis were enrolled,among whom 67 were diagnosed with moderate-to-severe GEV. There were significant differences in PLT,alanine aminotransferase,albumin,white blood cell count,and international normalized ratio between the none-to-mild GEV group and the moderate-to-severe GEV group( Z =-6. 508,-2. 132,-2. 470,-4. 510,and-5. 298,all P < 0. 05). There were also significant differences in spleen stiffness measured by 2 D-SWE,spleen diameter,and PLT/spleen diameter ratio between the two groups( Z =-7. 264,-5. 924,and-7. 028,all P < 0. 05). The PLT/sple
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