实时组织弹性成像联合APRI和FIB-4预测乙型肝炎肝硬化患者并发食管静脉曲张价值分析*

doi:10.3969/j.issn.1672-5069.2026.02.025

摘要/Abstract

摘要： 目的探讨采用实时组织弹性成像联合天门冬氨酸氨基转移酶与血小板比值指数(APRI)和肝纤维化-4因子评分(FIB-4)预测乙型肝炎肝硬化患者并发食管静脉曲张(EV)的价值。方法 2021年1月～2024年12月郴州市第三人民医院诊治的111例乙型肝炎肝硬化患者,均接受胃镜检查。使用超声实时组织弹性成像技术检测肝组织弹性,自动计算肝纤维化指数(LF_index),常规临床检测并计算APRI和FIB-4。构建受试者工作特征曲线(ROC)分析预测效能。结果在本组111例乙型肝炎肝硬化患者中,胃镜检查发现并发EV者32例(28.8%);EV组外周血PLT计数为(96.6±13.4)×10⁹/L,显著低于非EV组【(128.4±18.3)×10⁹/L,P<0.05】,而两组肝功能指标无显著性差异(P>0.05);EV组LF_index、APRI和FIB-4分别为(3.4±0.7)、(1.4±0.5)和(4.3±0.6),均显著高于或大于非EV组【分别为(2.2±0.4)、(0.5±0.2)和(1.9±0.3),P<0.05】; ROC曲线分析表明,LF_index联合APRI和FIB-4预测乙型肝炎肝硬化患者并发EV的AUC值为0.985,其灵敏度为92.6%,特异度为97.1%,显著优于各指标单独预测(P<0.05)。结论采用实时组织弹性成像检测联合APRI和FIB-4预测乙型肝炎肝硬化患者发生EV有一定的临床应用价值,值得扩大验证。

关键词: 肝硬化, 食管静脉曲张, 实时组织弹性成像, 天门冬氨酸氨基转移酶与血小板比值指数, 肝纤维化-4因子评分, 诊断

Abstract: Objective This study aimed to investigate the predictive performance of real-time tissue elastography with combination of aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis factor-4 (FIB-4) for esophageal varices (EV) in patients with hepatitis B-induced liver cirrhosis (LC). Methods A total of 111 patients with hepatitis B-induced LC were encountered in Chenzhou Third People's Hospital between January 2021 and December 2024, and all underwent gastroscopy for evaluation of EV. Liver fibrosis index (LF_index) was obtained by using real-time tissue elastography check-up, and APRI and FIB-4 scores were routinely calculated. The predictive efficacy of these parameters for EV occurrence was analyzed by using receiver operating characteristic (ROC) curves. Results Of the 111 patients with hepatitis B-induced LC, gastroscopy found EV in 32 cases(28.8%); PLT count in patients with EV was (96.6±13.4)×10⁹/L, much lower than [(128.4±18.3)×10⁹/L, P<0.05] in those without, while there was no significant differences respect to common liver function tests between the two groups (P>0.05); the LF_index, APRI and FIB-4 scores in patients with EV were (3.4±0.7), (1.4±0.5) and (4.3±0.6), all significantly higher or greater than [(2.2±0.4), (0.5±0.2) and (1.9±0.3), respectively, P<0.05] in those without EV; ROC analysis showed that the AUC was 0.985, with sensitivity of 92.6% and specificity of 97.1%, when the LF_index was combined with APRI and FIB-4 scores in predicting EV existence in patients with LC, much superior to any parameter did alone (P<0.05). Conclusion Real-time tissue elastography in combination with APRI and FIB-4 scores demonstrates an excellent predictive efficacy for EV in patients with hepatitis B-induced LC, which needs further clinical investigation.

Key words: Liver cirrhosis, Real-time tissue elastography, Esophageal varices, Aspartate aminotransferase-to-platelet ratio index, Fibrosis factor-4, Diagnosis

李军勇, 陈华, 黄毅利. 实时组织弹性成像联合APRI和FIB-4预测乙型肝炎肝硬化患者并发食管静脉曲张价值分析^*[J]. 实用肝脏病杂志, 2026, 29(2): 261-264.

Li Junyong, Chen Hua, Huang Yili. Predictive performance of real-time tissue elastography with combination of APRI and FIB-4 for esophageal varices in patients with hepatitis B-induced liver cirrhosis[J]. Journal of Practical Hepatology, 2026, 29(2): 261-264.

参考文献

[1] Dusheiko G, Agarwal K, Maini MK. New approaches to chronic hepatitis B. N Engl J Med, 2023, 388(1): 55-69.
[2] Chien R N, Liaw Y F. Current trend in antiviral therapy for chronic hepatitis B. Viruses, 2022, 14(2): 434.
[3] Jothimani D, Rela M, Kamath P S. Liver cirrhosis and portal hypertension: how to deal with esophageal varices. Med Clin North Am, 2023, 107(3): 491-504.
[4] Song L, Zhao L, Deng J, et al. Staging liver fibrosis in patients with chronic hepatitis B using two-dimensional shear wave elastography based on histopathological findings: a prospective multicenter study. Quant Imaging Med Surg, 2023, 13(4): 2376.
[5] 唐平阳, 王洁冰, 张晓兰, 等. 血清HBeAg阴性乙型肝炎肝硬化患者APRI、FIB-4和血清TGF-β1水平变化. 实用肝脏病杂志, 2020, 23(6): 801-804.
[6] 代海峰, 王甜, 雷迅, 等. 应用瞬时弹性成像技术联合APRI和AAR指数评估乙型肝炎肝硬化患者肝纤维化临床价值研究. 实用肝脏病杂志, 2021, 24(2): 196-199.
[7] 中华医学会肝病学分会. 肝硬化诊治指南.实用肝脏病杂志,2019,22(6):770-792.
[8] Yuen M F, Lim S G, Plesniak R, et al. Efficacy and safety of bepirovirsen in chronic hepatitis B infection. N Engl J Med, 2022, 387(21): 1957-1968.
[9] Phillips S, Jagatia R, Chokshi S. Novel therapeutic strategies for chronic hepatitis B. Virulence, 2022, 13(1): 1111-1132.
[10] Feld J J, Lok A S, Zoulim F. New perspectives on development of curative strategies for chronic hepatitis B. Clin Gastroenterol Hepatol, 2023, 21(8): 2040-2050.
[11] Elghezewi A, Hammad M, El-Dallal M, et al. Trends in hospitalizations of esophageal varices from 2011 to 2018: A united states nationwide study. Gastroenterol Res, 2023, 16(3): 171.
[12] Singh S, Chandan S, Vinayek R, et al. Comprehensive approach to esophageal variceal bleeding: from prevention to treatment. World J Gastroenterol, 2024, 30(43): 4602.
[13] Hafez H A, Ramzy I, Mohamed E L K, et al. Efficacy of real-time tissue elastography (HI-RTE) for the evaluation of hepatic fibrosis in patients with chronic hepatitis C. Med J Cairo Univ, 2022, 90(3): 335-343.
[14] Hafez H A, Ramzy I, Mohamed E L K, et al. Comparison between real-time tissue elastography (HI-RTE) and fibroscan in assessment of liver fibrosis in chronic HCV patients. Med J Cairo Univ, 2022, 90(3): 359-366.
[15] Kang N L, Ruan Q F, Zhang D S, et al. Advantages of a novel model for predicting hepatic fibrosis in chronic hepatitis B virus carriers compared with APRI and FIB-4 scores. J Clin Transl Hepatol, 2022, 10(3): 412.
[16] Gür-Altunay D, Yürük-Atasoy P. How successful are APRI and FIB-4 scores in predicting liver fibrosis in chronic hepatitis B patients. Infect Dis Clin Microbiol, 2023, 5(4): 332.
[17] 徐航飞, 王宇, 何福亮, 等. 非肝硬化性门静脉高压食管静脉曲张出血风险的无创评估. 中华肝脏病杂志, 2022, 30(10): 1092-1099.
[18] Moosavy S H, Eftekhar E, Davoodian P, et al. AST/ALT ratio, APRI, and FIB-4 compared to fibroScan for the assessment of liver fibrosis in patients with chronic hepatitis B in bandar abbas, hormozgan, Iran. BMC Gastroenterol, 2023, 23(1): 145.
[19] Huang C F, Jang T Y, Jun D W, et al. On-treatment gamma-glutamyl transferase predicts the development of hepatocellular carcinoma in chronic hepatitis B patients. Liver Int, 2022, 42(1): 59-68.
[20] Najafi N, Razavi A, Jafarpour H, et al. Evaluation of hepatic injury in chronic hepatitis B and C using APRI and FIB-4 indices compared to fibroscan results. Ann Med Surg, 2024, 86(7): 3841-3846.

实时组织弹性成像联合APRI和FIB-4预测乙型肝炎肝硬化患者并发食管静脉曲张价值分析^*

Predictive performance of real-time tissue elastography with combination of APRI and FIB-4 for esophageal varices in patients with hepatitis B-induced liver cirrhosis

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	常静霞, 张丽, 盖琳, 张田龙, 郑爱兰, 郭煜. 瞬时弹性成像联合FIB-4和APRI评估慢性乙型肝炎患者肝纤维化价值研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 183-186.
[2]	黄炎芳, 李远, 李政, 黎坚. 血清腱糖蛋白-C和多种肝纤维化指数诊断慢性乙型肝炎患者肝纤维化效能研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 187-190.
[3]	张卉新, 隋雪梅. 声触诊组织量化技术联合其他指标诊断慢性乙型肝炎患者肝纤维化效能临床研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 191-194.
[4]	张萌, 许怀利, 杨小飞, 杨湘敏, 张鹏飞. 非酒精性脂肪性肝病患者血清趋化因子CXCL12及其受体CXCR4和CXCR7水平变化临床意义研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 205-208.
[5]	吴娟, 段艳, 乞艳华. 超声受控衰减参数与二维超声剪切波弹性成像评估代谢功能障碍相关脂肪性肝病患者肝纤维化效能比较^*[J]. 实用肝脏病杂志, 2026, 29(2): 217-220.
[6]	储茜, 景龙宵, 张力, 孙恒亮. 血清PCT、IL-26和IFN-γ水平联合MELD评分预测慢加急性乙型肝炎肝衰竭患者感染价值探讨^*[J]. 实用肝脏病杂志, 2026, 29(2): 233-236.
[7]	孙博汉, 曹春莉, 奇丽娜. MELD评分联合血清胱抑素C和ALBI评分诊断失代偿期肝硬化患者并发肝肾综合征价值研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 249-252.
[8]	岳国栋, 孙山峰, 常书娟, 刘钟歆. 超声剪切波成像技术检测预测肝硬化患者并发食管静脉曲张破裂出血价值分析^*[J]. 实用肝脏病杂志, 2026, 29(2): 253-256.
[9]	孙恒亮, 蒋海薇, 张力. 乙型肝炎肝硬化患者多重耐药菌感染率、病原菌分布和影响因素分析^*[J]. 实用肝脏病杂志, 2026, 29(2): 257-260.
[10]	周慧敏, 王娜, 刘晶晶, 郭亚荣, 柴宝. 内镜下硬化剂治疗肝硬化并发食管静脉曲张破裂出血患者心肌损伤临床研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 265-268.
[11]	李艳慧, 张效良, 李兰花. 失代偿期肝硬化并发自发性细菌性腹膜炎患者血清sTREM-1和PCT水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2026, 29(2): 269-272.
[12]	刘立楠, 常宇飞, 王卉. 肝硬化并发脓毒症患者SOFA评分和MELD-Na⁺评分变化及其临床意义探讨[J]. 实用肝脏病杂志, 2026, 29(2): 273-276.
[13]	何阳, 张屹俊, 侯毅斌, 周粟, 杨柏帅, 袁敏. 经颈静脉肝内门体分流术治疗肝硬化并发脾功能亢进症患者疗效研究[J]. 实用肝脏病杂志, 2026, 29(2): 277-280.
[14]	吉盛超, 耿承军, 陆泽华, 叶黛西, 冯浩, 金晓凤, 陈利华. 基于增强CT和MRI参数构建模型鉴别诊断不典型肝细胞癌与肿块型肝内胆管细胞癌价值研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 281-284.
[15]	石国富, 朱志韬, 张苏波, 金怀玉. MSCT联合增强MRI鉴别诊断肝脏局灶性结节性增生与肝细胞癌价值研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 301-304.