病毒性肝炎肝硬化食管静脉曲张无创评估方法的预测价值比较  

Predictive value comparison of noninvasive methods for assessment of esophageal varices in viral hepatitis cirrhosis

作　　者：汪思远 雷淼 赵文 Wang Siyuan;Lei Miao;Zhao Wen(Department of Infectious Diseases,the First Affiliated Hospital of Bengbu Medical University,Bengbu,Anhui 233000,China)

机构地区：[1]蚌埠医学院第一附属医院传染性疾病科,安徽蚌埠233000

出　　处：《齐齐哈尔医学院学报》2024年第2期118-123,共6页Journal of Qiqihar Medical University

基　　金：安徽省卫生健康科研项目(AHWJ2022b069);安徽省高等学校科学研究项目(2022AH051499)。

摘　　要：目的比较无创模型对病毒性肝炎肝硬化患者食管静脉曲张(EV)程度的预测价值,寻找简单可靠的无创诊断方法。方法回顾性分析2020年10月—2022年10月在河北医科大学第三医院及蚌埠医学院第一附属医院行内镜检查的肝硬化患者252例临床资料,其中病毒性肝炎肝硬化患者146例。采集患者血常规、肝功能、凝血功能、腹部超声及胃镜检查结果,计算AAR、APRI、GPRI等一系列无创模型。比较全部肝硬化和病毒性肝炎肝硬化患者食管静脉曲张发生情况,采用受试者工作特征(ROC)曲线评价无创模型单独及联合对食管静脉曲张的诊断性能。结果肝硬化EV患者的白细胞(WBC)、血小板(PLT)、白蛋白(ALB)明显低于无EV患者(P<0.05),而总胆红素(TBil)、血浆凝血酶原(PT)、脾直径(SD)等水平增加,病毒性肝炎肝硬化患者中结果相似;血红蛋白(Hb)、PLT随EV程度加重而降低,SD、脾厚度(ST)、门静脉直径(PVD)随EV加重增加(P<0.05)。FIB-4、Fibro-Q、LOK指数、PC/SD模型与食管静脉曲张程度均有良好相关性(r均>0.3)。PC/SD预测肝硬化中重度食管静脉曲张准确性最佳,其ROC曲线下面积,敏感性和特异性分别是0.763、0.880、0.594,优于Fibro-Q、FIB4、Lok指数的预测价值(P均<0.05);PC/SD联合Fibro-Q、FIB-4、Lok指数对食管静脉曲张程度的预测价值与单独诊断无显著差异(P>0.05)。结论PC/SD可准确预测全部肝硬化和病毒性肝炎肝硬化患者中、重度食管静脉曲张,其与其他模型的联合诊断价值与单独诊断无显著差异。Objective To compare the predictive value of noninvasive models for assessing the degree of esophageal varices(EV)in cirrhotic patients with viral hepatitis,and search for simple and reliable noninvasive diagnostic methods.Methods The clinical data of 252 patients with cirrhosis who underwent endoscopic examination in the Third Hospital of Hebei Medical University and the First Affiliated Hospital of Bengbu Medical University from October 2020 to October 2022 were retrospectively analyzed,including 146 patients with viral hepatitis cirrhosis.The results of blood routine examination,liver function,coagulation function,abdominal ultrasound and gastroscopy were collected.A series of noninvasive models such as AAR,APRI,GPRI,etc.were calculated.The incidence of esophageal varices in all patients with liver cirrhosis and viral hepatitis cirrhosis was compared.Receiver operating characteristic(ROC)curve was used to evaluate the performance of the noninvasive model alone and in combination diagnosing esophageal varices.Results The white blood cell(WBC),platelet(PLT),albumin(ALB)in patients with cirrhosis EV were lower than those of patients without EV(P<0.05),but the level of the total bilirubin(Tbil),plasma plasminogen(PT),spleen diameter(SD)increased,and the patients with viral cirrhosis had the similar results.The hemoglobin(Hb),PLT decreased with increasing degrees of EV,and the SD,splenic thickness(ST),portal vein diameter(PVD)increased with increased degrees of EV(P<0.05).The FIB-4,Fibro-Q,LOK score,PC/SD all had correlate well with the degrees of EV(all r>0.3).PC/SD had the best accuracy in predicting moderate and severe esophageal varices in cirrhosis,and the area under the ROC curve,sensitivity and specificity were 0.763,0.880,0.594,respectively,which were better than the predictive value of the Fibro-Q,FIB4,and Lok indices(All P<0.05).However,the value of PC/SD combined with Fibro-Q,FIB-4,and Lok index in predicting the degree of esophageal varices was not significantly different from the individual diagnosis(P

关 键 词：肝硬化 食管静脉曲张 无创模型 预测价值 

分 类 号：R512.6[医药卫生—内科学]