基于超声参数的半定量评分评估乙型肝炎肝硬化食管静脉曲张价值探讨*

doi:10.3969/j.issn.1672-5069.2022.06.025

摘要/Abstract

摘要： 目的探讨基于超声参数的半定量评分评估乙型肝炎肝硬化食管静脉曲张(EV)程度的应用价值。方法 2020年6月～2022年1月我院接受胃镜检查的乙型肝炎肝硬化患者124例,常规行肝脏超声检查并进行半定量评分,基于血生化结果和人口学资料计算基于4因子的纤维化指数(FIB-4)和天门冬氨酸氨基转移酶/血小板计数指数(APRI),绘制受试者工作特征曲线评价各指标评估中重度EV的效能。结果在124例乙型肝炎肝硬化患者中,胃镜检查提示G0期46例(37.1%)、G1期30例(24.2%)、G2期28例(22.6%)和G3期20例(16.1%),其中中重度EV(G2/G3)患者48例(38.7%);G2/G3期患者超声半定量评分、FIB-4和APRI水平分别为(13.1±1.9)、(5.7±1.1)和(1.7±0.3),显著高于G1期【分别为(11.8±1.5)、(4.2±0.7)和(1.1±0.2),P<0.05】或G0期【分别为(10.8±1.7)、(2.7±0.5)和(0.7±0.2),P<0.05】;超声半定量评分、FIB-4和APRI评估中重度EV的截断点分别为12.7、5.0和1.4,其灵敏度和特异度分别为91.7%和73.7%、89.6%和67.1%,和87.5%和72.4%,各指标的诊断效能无显著性差异(P>0.05)。结论基于超声参数的半定量评分作为一种无创诊断手段评估乙型肝炎肝硬化患者中重度EV也有一定的应用价值,值得深入探讨。

关键词: 肝硬化, 食管静脉曲张, 内镜检查, 肝脏超声半定量评分, 诊断

Abstract: Objective The aim of this study was to explore the application of semi-quantitative scoring (SQS) based on ultrasonography in evaluating the severity of esophageal varices (EV) in patients with hepatitis B cirrhosis. Methods 124 patients with hepatitis B cirrhosis underwent gastroscopy in our hospital between June 2020 and January 2022. The routine liver ultrasonography and semi-quantitative scoring were conducted. Based on blood biochemical index and demographic data, the fibrosis index based on the four factors (FIB-4) and aspartate aminotransferase/platelet index (APRI) were calculated. The evaluation efficacy of each index for moderate to severe EV was assessed by receiver operating characteristic (ROC) curves. Results The gastroscopy showed that among the 124 patients with hepatitis B cirrhosis, there were 46 cases (37.1%) in stage G0, 30 cases (24.2%) in stage G1, 28 cases (22.6%) in stage G2 and 20 cases (16.1%) in stage G3 of EV, e.g. 48 cases (38.7%) with moderate to severe EV (G2-G3); the SQS, FIB-4 and APRI scores in patients at stages G2-G3 were (13.1±1.9), (5.7±1.1) and (1.7±0.3), significantly higher than [(11.8±1.5) , (4.2±0.7) and (1.1±0.2), P<0.05] in patient with stage G1 or [(10.8±1.7) , (2.7±0.5) and (0.7±0.2), respectively, P<0.05] in those with stage G0; the cut-off values of SQS, FIB-4 and APRI for assessing moderate to severe EV were 12.7, 5.0 and 1.4, respectively, and their sensitivity and specificity were 91.7% and 73.7%, 89.6% and 67.1%, and 87.5% and 72.4%, without significant differences as respect to the diagnostic performance among them (P>0.05). Conclusion As a non-invasive approach, the application of semi-quantitative scoring based on ultrasonography is practical in evaluating moderate to severe EV in patients with hepatitis B cirrhosis.

Key words: Liver cirrhosis, Esophageal varices, Digestive endoscope, Ultrasonography, Semi-quantitative scoring, Diagnosis

李响, 张铁英, 张旭辉, 孟繁坤. 基于超声参数的半定量评分评估乙型肝炎肝硬化食管静脉曲张价值探讨^*[J]. 实用肝脏病杂志, 2022, 25(6): 857-860.

Li Xiang, Zhang Tieying, Zhang Xuhui, et al.. Evaluation of esophageal varices by semi-quantitative scoring based on ultrasonography in patients with hepatitis B cirrhosis[J]. Journal of Practical Hepatology, 2022, 25(6): 857-860.

参考文献

[1] 古川, 徐小元, 熊辉. 肝硬化食管胃静脉曲张的一级预防和二级预防. 实用肝脏病杂志, 2016, 19(5):513-515.
[2] Seo YS . Prevention and management of gastroesophageal varices. Clin Mol Hepatol, 2018, 24(1):20-42.
[3] Jakab SS, Garcia-Tsao G. Evaluation and management of esophageal and gastric varices in patients with cirrhosis. Clin Liver Dis, 2020, 24(3):335-350.
[4] Lenzen H , Musmann E, Kottas M , et al. Acute gastrointestinal bleeding cases presenting to the emergency department are associated with age, sex and seasonal and circadian factors. Eur J Gastroenterol Hepatol, 2017, 29(1):78-83.
[5] 肖勇, 于红刚, 陈明锴. 肝硬化门静脉高压食管胃静脉曲张出血的内镜诊治策略. 中华消化内镜杂志, 2018, 35(2):84-88.
[6] Kim BK, Han KH, Park JY, et al. A liver stiffness measurement-based, noninvasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis. Am J Gastroenterol, 2010, 105(6):1382-1390.
[7] 中华医学会肝病学分会和感染病学分会.慢性乙型肝炎防治指南(2015年版). 实用肝脏病杂志, 2016, 19(3):Ⅴ-ⅩⅩⅢ.
[8] 刘成海, 危北海, 姚树坤. 肝硬化中西医结合诊疗共识. 中国中西医结合杂志, 2011, 19(4):277-279.
[9] 武金玉, 陈敏华, 戴莹,等. 超声对肝纤维化和肝硬化半定量诊断探讨-肝被膜形态及肝内韧带观察. 中华超声杂志, 2003, 12(8):478-481.
[10] 杨晴, 刘东屏, 李鲁平,等. 慢性乙型肝炎肝纤维化非创伤性诊断模型的建立与评价. 中华肝脏病杂志, 2017, 25(1):15-20.
[11] Zhang GM, Xia YJ. Reference intervals of fibrosis index based on four indicators in healthy elderly Chinese. J Clin Lab Anal, 2016, 30(5):645-648.
[12] 中华医学会肝病学分会、消化病学分会、内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南. 实用肝脏病杂志, 2016, 19(5):Ⅰ-ⅩⅤⅠ.
[13] 王春妍, 蒋贝, 李嘉,等. 超声内镜对肝硬化患者胃食管静脉曲张早期诊断价值的评估. 中华肝脏病杂志, 2016, 24(9):671-675.
[14] Mathur SK, Shah SR, Soonawala ZF, et al. Transabdominal extensive oesophagogastric devascularization with gastro-oesophageal stapling in the management of acute variceal bleeding. Br J Surg, 2015, 84(3):413-417.
[15] Bintintan A, Chira RI, Mircea PA. Non-invasive ultrasound-based diagnosis and staging of esophageal varices in liver cirrhosis. a systematic review of the literature published in the third millenium. Med Ultrason, 2013, 15(2):116-124.
[16] 魏华, 马旭艳. 彩色多普勒超声半定量评分对早期乙型肝炎肝硬化的诊断价值. 实用肝脏病杂志, 2017, 20(1):78-80.
[17] 林诗彬, 郑恩海, 杨克丰,等. 彩色多普勒超声检查对乙型肝炎肝硬化患者食管静脉曲张预测价值分析. 实用肝脏病杂志, 2019, 22(3):409-412.
[18] Lurie Y, Webb M, Cytter-Kuint R, et al. Non-invasive diagnosis of liver fibrosis and cirrhosis. World J Gastroenterol, 2015, 21(41):11567-1183.
[19] Karanjia RN, Crossey MM, Cox IJ, et al. Hepatic steatosis and fibrosis: Non-invasive assessment. World J Gastroenterol, 2016, 22(45):9880-9897.
[20] Jakab SS, Garcia-Tsao G. Evaluation and management of esophageal and gastric varices in patients with cirrhosis. Clin Liver Dis, 2020, 24(3):335-350.
[21] Mooney P, Hayes P, Smith K. The putative use of alpha-1-acid glycoprotein as a non-invasive marker of fibrosis. Biomed Chromatogr, 2006, 20(12):1351-1358.
[22] Yin Z, Zou J, Li Q, et al. Diagnostic value of FIB-4 for liver fibrosis in patients with hepatitis B:a meta- analysis of diagnostic test. Oncotarget, 2017, 8(14):22944-22953.
[23] 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. 实用肝脏病杂志, 2020, 23(4):560-563.

基于超声参数的半定量评分评估乙型肝炎肝硬化食管静脉曲张价值探讨^*

Evaluation of esophageal varices by semi-quantitative scoring based on ultrasonography in patients with hepatitis B 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]	韩涛, 刘艳迪, 胡家轩. 肝病合并肾损伤临床诊治新进展[J]. 实用肝脏病杂志, 2022, 25(6): 761-763.
[2]	蒋莹莹, 丁惠国. 肝硬化并发急性肾损伤临床管理现状与挑战[J]. 实用肝脏病杂志, 2022, 25(6): 764-767.
[3]	韩芳, 李佳峥, 南月敏. 肝硬化并发急性肾损伤诊治进展[J]. 实用肝脏病杂志, 2022, 25(6): 768-771.
[4]	蔡勇, 李璟, 欧琴. 2型糖尿病合并非酒精性脂肪性肝病患者血清网膜素、视黄醇结合蛋白4和Ⅰ型原胶原氨基端前肽水平及意义分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 800-803.
[5]	王玉梅, 袁向东, 刘玉玲, 赵子瑜. 提示肥胖症儿童/青少年存在非酒精性脂肪性肝炎的指标分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 808-811.
[6]	沈亦亮, 沈冬元, 陈永莹, 江凯, 朱逸明, 葛尚. 肝硬化患者肝内LR-3类结节恶变风险评估及预测模型的建立^*[J]. 实用肝脏病杂志, 2022, 25(6): 836-839.
[7]	徐超, 李兰, 罗东, 赵海云, 彭飞. TIPS术治疗的肝硬化并发EVB患者医院内死亡风险预测模型的构建与应用^*[J]. 实用肝脏病杂志, 2022, 25(6): 840-843.
[8]	林秀慧, 李南, 张娇珍, 符庆忠, 林秀华. 慢性HBV感染者外周血PNPLA3/PRKAA1基因多态性与肝硬化发生关系研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 844-847.
[9]	朱海艳, 范晓棠. 肝硬化并发门静脉血栓形成患者列线图预测模型分析及外部验证[J]. 实用肝脏病杂志, 2022, 25(6): 848-852.
[10]	孙静, 张伟伟, 马智勇, 代树本, 邓彦东. 经颈静脉肝内门体分流术联合胃冠状静脉栓塞术治疗乙型肝炎肝硬化并发食管胃静脉曲张患者效果分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 853-856.
[11]	张耀辉, 郑章增, 高星, 张亚利. 超声造影时间-强度曲线诊断肝硬化患者肝内小结节病灶价值研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 861-864.
[12]	詹致远, 申洋, 王凡冰. 内镜下套扎术联合奥美拉唑和奥曲肽治疗肝硬化并发食管静脉曲张首次出血患者短期疗效分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 865-868.
[13]	邬政宏, 吴冬秋, 刘四斌. DCE-MRI诊断原发性肝癌效能和TACE术后评估肿瘤活性应用价值研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 881-884.
[14]	黄玮, 范智慧, 陈磊, 王丹. 脂肪肝对超声造影诊断肝内炎性假瘤的影响^*[J]. 实用肝脏病杂志, 2022, 25(6): 897-900.
[15]	沈一芃, 祝峻峰. 肝硬化并发自发性细菌性腹膜炎临床研究进展^*[J]. 实用肝脏病杂志, 2022, 25(6): 909-912.