FibroScan联合多种预测模型预测肝硬化患者食管静脉曲张程度应用价值探讨

doi:10.3969/j.issn.1672-5069.2020.04.027

摘要/Abstract

摘要： 目的探讨应用FibroScan和其他指标评判肝硬化患者食管静脉曲张(EV)程度的临床价值。方法 142例肝硬化患者接受胃镜检查,了解食管胃底静脉曲张情况,使用FibroScan检测肝脏硬度值(LSM),计算天冬氨酸氨基转移酶/血小板比值指数(APRI)、基于 4 因子的纤维化指数(FIB- 4)和γ-谷氨酰转肽酶/血小板计数模型(GPR),绘制受试者工作特征曲线(ROC),并计算曲线下面积(AUROC),评价各指标评判EV的临床价值。结果本组患者经胃镜检查,发现无EV组49例,有EV组93例(G1 28例,G2 30例,G3 35例);EV组LSM、APRI、FIB-4和GPR分别为(25.8±1.6)kPa、(1.5±0.1)、(5.3±0.3)和(0.9±0.1),均显著大于无EV组【分别为(15.2±1.5)kPa、(0.7±0.1)、(2.9±0.3)和(0.4±0.1),P<0.05】;严重EV组LSM、APRI、FIB-4和GPR也显著大于无EV或轻度EV组;LSM、APRI、FIB-4和GPR判断EV≥G2的截断点分别为19.20 kPa、1.9、4.9和0.5,其诊断的灵敏度和特异度分别为68.7%和96.7%、60.0%和89.80%、61.5%和91.80%,和60.0%和85.70%。结论应用FibroScan、APRI、FIB-4和GPR等无创性指标可以预测肝硬化患者食管静脉曲张的存在,对不能行胃镜检查的患者可作为一种替代方法而做出判断。

关键词: 肝硬化, 静脉曲张, 无创肝纤维化诊断模型, 诊断

Abstract: Objective The aim of this study was to explore the value of liver stiffness measurement (LSM) , aspartate aminotransferase- to- platelet ratio index (APRI), fibrosis index based on the 4 factors (FIB- 4) and gamma-glutamyl transpeptidase to platelet ratio (GPR) in predicting the degree of esophageal varices (EV) in patients with liver cirrhosis (LC). Methods 142 patients with LC underwent electronic gastroscopy, LSM was detected by FibroScan, and ARPI, FIB-4 and GPR scores were calculated. The receiver operating characteristic curve (ROC) and the area under ROC (AUROC) were obtained to determine the diagnostic efficacy. Results Out of the 142 patients with LC, the gastroscopy showed EV in 93 patients (G1 in 28,G2 in 30,G3 in 35) and non-EV in 49; the LSM, APRI, FIB-4 and GPR in patients with EV were (25.8±1.6)kPa, (1.5±0.1), (5.3±0.3) and (0.9±0.1), all significantly greater than 【(15.2±1.5)kPa, (0.7±0.1), (2.9±0.3) and (0.4±0.1), respectively, P<0.05】 in patients without EV; the LSM, APRI, FIB-4 and GPR in patients with severe EV were greater than those in patients without or with mild EV; the cut-off-value of LSM, APRI, FIB-4 and GPR in predicting EV≥G2 were 19.20 kPa, 1.9, 4.9 and 0.5, respectively, and their diagnostic sensitivities and specificities were 68.7% and 96.7%, 60.0% and 89.80%, 61.50% and 91.80%, and 60.0% and 85.70%, respectively. Conclusion The application of non-invasive approaches , such as FibroScan and serum index of APRI, FIB-4 and GPR might help clinicians to predict the existence of EV in patients with LC, which warrants further investigation.

Key words: Liver cirrhosis, Esophageal varices, Non-invasive liver fibrosis model, Diagnosis

李娜, 郑少秋, 赵守松. FibroScan联合多种预测模型预测肝硬化患者食管静脉曲张程度应用价值探讨[J]. 实用肝脏病杂志, 2020, 23(4): 560-563.

Li Na, Zheng Shaoqiu, Zhao Shousong. Application of FibroScan, APRI,FIB-4 and GPR in prediction of esophageal varices in patients with liver cirrhosis[J]. Journal of Practical Hepatology, 2020, 23(4): 560-563.

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