不同无创诊断模型对代偿期乙型肝炎肝硬化显著门静脉高压食管胃静脉曲张的诊断价值  

Value of different noninvasive diagnostic models in the diagnosis of esophageal and gastric varices with significant portal hypertension in compensated hepatitis B cirrhosis

作　　者：刘诚 曾嘉旖 方梦冰 陈智恒 桂蓓 赵凤鸣 袁靖凯 张朝臻 施梅姐 谢玉宝 池晓玲 萧焕明 LIU Cheng;ZENG Jiayi;FANG Mengbing;CHEN Zhiheng;GUI Bei;ZHAO Fengming;YUAN Jingkai;ZHANG Chaozhen;SHI Meijie;XIE Yubao;CHI Xiaoling;XIAO Huanming(The Second Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510006,China;The Liver Department,Guangdong Provincial Hospital of Traditional Chinese Medicine,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510006,China)

机构地区：[1]广州中医药大学第二临床医学院,广州510006 [2]广东省中医院,广州中医药大学第二附属医院肝病科,广州510006

出　　处：《临床肝胆病杂志》2025年第2期263-268,共6页Journal of Clinical Hepatology

基　　金：国家“十三五”重大传染病专项课题(2018ZX10725506-003,2018ZX10725505-004);广东省中医药防治难治性慢病重点实验室项目(中医二院[2023]200号);广东省自然科学基金(2022A1515220188,2023A1515011092,2022A1515110825);广东省院内专项(YN10101903,YN2016XP03,YN2022DB04,YN2023MB04);池晓玲国家中医药管理局名老中医药专家传承工作室项目(国中医药人教函[2022]75号);第五批全国中医临床优秀人才研修项目(国中医药人教函[2022]1号)。

摘　　要：目的代偿期乙型肝炎肝硬化显著门静脉高压患者发生食管胃静脉曲张(GOV)风险较大,通过评价不同无创诊断模型对GOV的诊断价值,为早期诊断GOV提供依据。方法选取2017年11月—2023年11月广东省中医院就诊的代偿期乙型肝炎肝硬化显著门静脉高压患者108例,根据胃镜下是否伴发GOV将患者分为GOV组和非GOV组(NGOV组)。收集患者的年龄、性别、影像学、实验室指标等结果。计数资料组间比较采用χ^(2)检验;正态分布的计量资料两组间比较采用成组t检验;非正态分布的数据两组间比较采用Mann-Whitney U检验。采用受试者操作特征曲线(ROC曲线)评估FIB-4、LOK指数、LPRI、APRI、AAR等5种评分模型的诊断价值;利用二元Logistic回归构建联合模型,将联合模型与5种评分模型单独应用时的ROC曲线下面积(AUC)比较;采用Delong检验对各无创诊断模型的AUC值进行两两比较。结果GOV组55例,NGOV组53例。GOV组的年龄高于NGOV组[(52.64±1.44)岁vs(47.96±1.68)岁],ALT[42.00(24.00~117.00)U/L vs 82.00(46.00~271.00)U/L]、AST[44.00(32.00~96.00)U/L vs 62.00(42.50~154.50)U/L]、PLT[100.00(69.00~120.00)×109/L vs 119.00(108.50~140.50)×109/L]低于NGOV组,差异均有统计学意义(统计值分别为3.230、−3.065、−2.351、−3.667,P值均<0.05)。ROC曲线分析显示,FIB-4、LOK指数、LPRI、AAR单独诊断GOV的AUC分别为0.667、0.681、0.730、0.639(P值均<0.05),GOV阳性诊断率分别为69.97%、65.28%、67.33%、58.86%,AUC值比较差异均无统计学意义(P值均>0.05),APRI单独应用无诊断价值(P>0.05)。利用二元Logistic回归构建联合模型LAF,AUC为0.805,GOV阳性诊断率为75.80%,明显高于FIB-4、LOK指数、LPRI、AAR单独应用时的AUC值(Z值分别为−2.773、−2.479、−2.206、−2.672,P值均<0.05)。结论FIB-4、LOK指数、LPRI、AAR对代偿期乙型肝炎肝硬化显著门静脉高压患者发生GOV诊断价值相似,APRI单独应用无诊断价值,联合模型LAF的诊断�Objective To investigate the value of different noninvasive diagnostic models in the diagnosis of esophageal and gastric varices since there is a high risk of esophageal and gastric varices in patients with compensated hepatitis B cirrhosis and significant portal hypertension,and to provide a basis for the early diagnosis of esophageal and gastric varices.Methods A total of 108 patients with significant portal hypertension due to compensated hepatitis B cirrhosis who attended Guangdong Provincial Hospital of Traditional Chinese Medicine from November 2017 to November 2023 were enrolled,and according to the presence or absence of esophageal and gastric varices under gastroscopy,they were divided into esophageal and gastric varices group(GOV group)and non-esophageal and gastric varices group(NGOV group).Related data were collected,including age,sex,imaging findings,and laboratory markers.The chi-square test was used for comparison of categorical data between groups;the least significant difference 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 receiver operating characteristic(ROC)curve was plotted to evaluate the diagnostic value of five scoring models,i.e.,fibrosis-4(FIB-4),LOK index,LPRI,aspartate aminotransferase-to-platelet ratio index(APRI),and aspartate aminotransferase/alanine aminotransferase ratio(AAR).The binary logistic regression method was used to establish a combined model,and the area under the ROC curve(AUC)was compared between the combined model and each scoring model used alone.The Delong test was used to compare the AUC value between any two noninvasive diagnostic models.Results There were 55 patients in the GOV group and 53 patients in the NGOV group.Compared with the NGOV group,the GOV group had a significantly higher age(52.64±1.44 years vs 47.96±1.68 years,t=0.453,P<0.05)and significantly lower levels of alanine aminotransferase[42.00(24.

关 键 词：肝硬化 乙型肝炎 高血压 门静脉 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]