血清-腹水白蛋白梯度对失代偿期乙型肝炎肝硬化患者发生EVB风险的预测价值*

doi:10.3969/j.issn.1672-5069.2021.05.008

摘要/Abstract

摘要： 目的研究血清-腹水白蛋白梯度(SAAG)预测失代偿期乙型肝炎肝硬化患者并发食管静脉曲张破裂出血(EVB)的临床价值。方法 2017年4月～2019年10月我院收治的失代偿期乙型肝炎肝硬化患者84例,根据是否发生EVB分组,计算SAAG和校正的SAAG值。采用Logistic多因素分析患者并发EVB的独立影响因素,采用受试者工作特征曲线(ROC)并计算曲线下面积(AUC)分析各指标预测EVB风险的临床价值。结果在随访的6个月内,本组发生EVB 18例,未发生66例;EVB患者年龄≥65岁的比例为72.2%,显著大于肝硬化患者(43.9%,P<0.05);EVB患者血清白蛋白水平为(35.8±2.7)g/L,显著低于肝硬化患者【(37.7±3.3)g/L,P<0.05】,血小板计数为(52.3±10.7)×10⁹/L,显著低于肝硬化患者【(59.4±12.5)×10⁹/L,P<0.05】,部分凝血酶原时间(APTT)为(45.8±5.9)s,显著长于肝硬化患者【(41.1±7.4)s,P<0.05】,SAAG为(18.7±5.1),显著大于肝硬化患者【(16.1±4.2),P<0.05】,矫正的SAAG为(9.2±2.4),显著大于肝硬化患者【(7.6±1.8),P<0.05】;脾脏厚度为(5.2±1.3)cm,显著大于肝硬化患者【(4.5±0.8)cm,P<0.05】,门静脉血流速度为(15.2±2.9)cm/s,显著慢于肝硬化患者【(17.0±3.3)cm/s,P<0.05】;Logistic多因素分析显示血清白蛋白(OR=0.435,95%CI=0.287～0.659)、腹水白蛋白(OR=1.845,95%CI=1.063～3.202)、APTT(OR=1.469,95%CI=1.272～1.697)、MELD评分(OR=3.285,95%CI=1.697～6.359)和矫正的SAAG(OR=2.917,95%CI=1.337～6.364)是影响失代偿期乙型肝炎肝硬化患者并发EVB的独立因素(P<0.05);采用校正的SAAG和MELD预测EVB的AUC分别为0.827和0.791,其敏感度分别为0.889和0.787,特异度分别为0.636和0.612。结论采用矫正的SAAG有助于预测失代偿期乙型肝炎肝硬化患者并发EVB的风险,因其简单,值得临床应用验证。

关键词: 肝硬化, 食管静脉曲张破裂出血, 血清-腹水白蛋白梯度, 预测

Abstract: Objective The aim of this study was to investigate the clinical predicting value of serum ascites albumin gradient (SAAG) on esophageal variceal bleeding (EVB) risk in patients with decompensated hepatitis B cirrhosis. Methods 84 patients with decompensated hepatitis B cirrhosis were admitted to our hospital between April 2017 and October 2019, and the SAAG and modified SAAG werecalculated. The Logistic multivariate analysis was used to analyze the independent impacting factors on EVB in patients with decompensatedhepatitis B cirrhosis. The receiver operating characteristic curve (ROC) was drawn and the area under the ROC (AUROC) was calculated to predict the EVB risk. Results 18 out of our series had, and 66 patients had not EVB during six-month followed-up period; the percentage of male cases older than 65 yr in patients with EBV was 72.2%,greatly older than in patients without EBV (43.9%,P<0.05); serum albumin level in patients with EVB was (35.8±2.7)g/L, significantly lower than , blood platelet count was (52.3±10.7)×10⁹/L, significantly lower than , the APTT was (45.8±5.9)s, significantly longer than ,the SAAG was (18.7±5.1), significantly higher than , and the modified SAAG was (9.2±2.4), significantly higher than in patients without EVB; the spleen thickness was (5.2±1.3)cm, significantly higher than , and the portal vein blood flow velocity was (15.2±2.9) cm/s, significantly slower than in patients without EVB; the multivariate Logistic analysis showed that serum albumin level (OR=0.435, 95%CI=0.287-0.659), ascites albumin level(OR=1.845, 95%CI=1.063-3.202), the APTT(OR=1.469,95%CI=1.272-1.697), the MELD score (OR=3.285, 95%CI=1.697-6.359) and the modified SAAG(OR=2.917, 95%CI=1.337-6.364) were the independent impacting factors for EVB in patients with decompensated hepatitis B cirrhosis(P<0.05); the AUCs of modified SAAG and MELD score for predicting EVB were 0.827 and 0.791, respectively, and theirsensitivities were 0.889 and 0.787, and the specificities were 0.636 and 0.612, respectively. Conclusion The application of SAAG is helpful to predict the risk of EVB in patients with decompensated hepatitis B cirrhosis, and worth further clinical investigation.

Key words: Liver cirrhosis, Esophageal variceal bleeding, Serum ascites albumin gradient, Prediction

刘玉玲, 甄增国, 王慧娟, 万秀敏, 杨爽. 血清-腹水白蛋白梯度对失代偿期乙型肝炎肝硬化患者发生EVB风险的预测价值^*[J]. 实用肝脏病杂志, 2021, 24(5): 637-640.

Liu Yuling, Zhen Zengguo, Wang Huijuan, et al. Predicting value of serum ascites albumin gradient on esophageal variceal bleeding risk in patients with decompensated hepatitis B cirrhosis[J]. Journal of Practical Hepatology, 2021, 24(5): 637-640.

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血清-腹水白蛋白梯度对失代偿期乙型肝炎肝硬化患者发生EVB风险的预测价值^*

Predicting value of serum ascites albumin gradient on esophageal variceal bleeding risk in patients with decompensated hepatitis B cirrhosis

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