无创模型诊断乙肝肝硬化患者高危食管静脉曲张  

Non-Invasive Model for Diagnosing High-Risk Esophageal Varices in Patients with Hepatitis B Cirrhosis

作　　者：杨学平[1] 王雪梅 于静 何楠 潘国栋 张瑶[1] Yang Xueping;Wang Xuemei;Yu Jing;He Nan;Pan Guodong;Zhang Yao(Department of Ultrasound,Beijing Ditan Hospital Affiliated to Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院超声科,北京市100015

出　　处：《中国超声医学杂志》2025年第3期299-303,共5页Chinese Journal of Ultrasound in Medicine

基　　金：北京市属医院科研培育计划项目(No.PX2024066)。

摘　　要：目的 利用超声、弹性及实验室数据探索建立诊断高危食管静脉曲张(HREV)的无创模型。方法 收集202例乙肝肝硬化患者的临床资料。患者均经内镜、腹部超声、肝硬度、脾硬度(SSM)及实验室检查。根据内镜结果将患者分为低危食管静脉曲张(LREV)组及HREV组。采用单因素及多因素Logistic回归分析HREV的影响因子,根据回归系数建立HREV诊断模型。计算已有模型肝硬度×脾长径/血小板计数(LSPS)、血小板计数/脾长径(PC/SD)的值。应用受试者工作特征(ROC)曲线评估各模型诊断HREV的效能,比较各模型的准确度。结果 SSM、Child-Pugh scores(CS)为HREV的独立影响因子,建立模型:SC-HREV=0.208×SSM+0.450×CS-15.520,曲线下面积为0.946(P<0.001),取最优截断值-3.74时,敏感度、特异度、阳性预测值及阴性预测值分别为90.6%、89.6%、88.8%、91.3%。SC-HREV诊断准确度优于PC/SD(Z=5.073,P<0.001)、LSPS(Z=5.888,P<0.001)。结论 以SSM、CS为基础的SC-HREV是一种易获取、无创性的模型,可作为乙肝肝硬化患者HREV的筛查方法。Objective e To establish a non-invasive model for diagnosing high-risk esophageal varices(HREV)using ultrasound,elasticity,and laboratory data.Methods The clinical data of 202 patients with hepatitis B cirrhosis were collected.All patients underwent endoscopy,abdominal ultrasound,liver stiffness measurement(LSM),spleen stiffness measurement(SSM),and laboratory tests.Patients were divided into the low-risk esophageal varices(LREV)group and the HREV group based on endoscopic results.Univariate and multivariate Logistic regression ana-lyses were conducted to identify the influencing factors of HREV,and a diagnostic model for HREV was established based on the regression coefficients.The values of the liver stiffness measurement-spleen diameter to platelet ratio score(LSPS)model and the platelet count to spleen diameter ratio(PC/SD)were calculated.The receiver operating characteristic curve was used to evaluate the diagnostic performance of each model for HREV and compare their accu-racy.Results SSM and Child-Pughscores(CS)were independent influencing factors of HREV.A model was estab-lished:SC-HREV=0.208XSSM+0.450XCS-15.520.The area under the curve was 0.946(P<0.001).When the optimal cut-off value was set at-3.74,the sensitivity,specificity,positive predictive value,and negative predic-tive value were 90.6%,89.6%,88.8%,and 91.3%,respectively.The diagnostic accuracy of SC-HREV was superi-or to that of PC/SD(Z=5.073,P<0.001)and LSPS(Z=5.888,P<0.001).Conclusions SC-HREV based on SSM and CS is an casily accessible and non-invasive model,which can be used as a screening method for HREV in pa-tients with hepatitis Bcirrhosis.

关 键 词：乙型肝炎肝硬化 食管静脉曲张 无创模型 

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