肝脏硬度检测联合FIB-4指数和血清CHI3L1水平预测乙型肝炎肝硬化患者食管静脉曲张效能研究*

doi:10.3969/j.issn.1672-5069.2026.04.023

摘要/Abstract

摘要： 目的探讨应用肝脏硬度检测(LSM)联合纤维化-4因子(FIB-4)指数和血清壳多糖酶3样蛋白1(CHI3L1)水平预测乙型肝炎肝硬化患者食管静脉曲张(EV)的效能。方法 2023年1月～2025年1月我院收治的123例乙型肝炎肝硬化患者,均接受胃镜检查,记录EV发生情况。使用Fibro Scan502检测LSM,根据临床检测指标结果计算FIB-4指数,采用ELISA法检测血清CHI3L1水平。绘制受试者工作特征曲线(ROC)分析LSM联合FIB-4指数和血清CHI3L1水平的预测效能。结果胃镜检查发现存在EV者74例(60.2%),未发生EV者49例(39.8%); EV组LSM、FIB-4指数和血清CHI3L1水平分别为(16.7±3.8)kPa、(5.7±1.4)和(151.4±41.8)ng/ml,均显著高于非EV组【分别为(13.1±3.0)kPa、(4.5±1.0)和(122.5±20.2)ng/ml,P＜0.05】;15例重度EV患者LSM、FIB-4指数和CHI3L1水平分别为(19.5±3.9)kPa、(6.7±1.4)和(177.6±42.0)ng/ml,均显著高于或大于33例轻度组【分别为(15.5±3.8)kPa、(5.1±1.5)和(141.4±41.7)ng/ml,P＜0.05】或26例中度组【分别为(16.4±3.9)kPa、(5.7±1.3)和(148.9±42.0)ng/ml,P＜0.05】;ROC分析显示,LSM联合FIB-4指数和血清CHI3L1水平预测乙型肝炎肝硬化患者EV发生的曲线下面积值(AUC)为0.846(95%CI:0.770~0.905),其敏感度和特异度分别为68.9%和83.7%。结论监测LSM联合FIB-4指数和血清CHI3L1水平可帮助临床医生初步判断乙型肝炎肝硬化患者存在EV,为进一步诊治提供依据。

关键词: 肝硬化, 食管静脉曲张, 肝脏硬度检测, 纤维化-4因子, 壳多糖酶3样蛋白1, 诊断

Abstract: Objective The aim of this study was to investigate efficacy of liver stiffness measurement (LSM) in combination with fibrosis-4 (FIB-4) index and serum chitinase-3-like protein 1 (CHI3L1) levels in predicting esophageal varices (EV) in patients with hepatitis B-induced liver cirrhosis (LC). Methods A total of 123 patients with hepatitis B-induced liver cirrhosis were enrolled in this study between January 2023 and January 2025, and all patients underwent gastroscopy to record occurrence of EV. LSM was measured by Fibro Scan502, FIB-4 index was calculated based on clinical laboratory indexes, and serum CHI3L1 level was determined by ELISA. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive efficacy. Results Gastroscopy found EV in 74 cases (60.2%), and no obvious EV in another 49 cases (39.8%) out of our 123 patients; LSM, FIB-4 index and serum CHI3L1 level in patients with EV were (16.7±3.8)kPa, (5.7±1.4) and (151.4±41.8)ng/ml, all much higher or greater than [(13.1±3.0)kPa, (4.5±1.0) and (122.5±20.2)ng/ml,respectively, P＜0.05] in those without EV; LSM, FIB-4 index and serum CHI3L1 level in 15 patients with severe EV were (19.5±3.9)kPa, (6.7±1.4) and (177.6±42.0)ng/ml,all much higher or greater than [(15.5±3.8)kPa, (5.1±1.5) and (141.4±41.7)ng/ml,respectively, P＜0.05] in 33 patients with mild EV or [(16.4±3.9)kPa, (5.7±1.3) and (148.9±42.0)ng/ml,respectively, P＜0.05] in 26 patients with moderate EV; ROC analysis showed that the AUC was 0.846(95%CI:0.770-0.905),with sensitivity and specificity of 68.9% and 83.7%, respectively, when LSM was combined with FIB-4 index and serum CHI3L1 level in predicting existence of EV in patients with LC. Conclusion The combination of LSM, FIB-4 index and serum CHI3L1 level exhibit a promising predictive efficacy for EV occurrence in patients with hepatitis B-induced LC, which warrants further clinical verification.

Key words: Liver cirrhosis, Esophageal varices, Liver stiffness measurement, Fibrosis-4 index, Chitinase-3-like protein 1, Diagnosis

李立方, 王朝阳, 李泽信. 肝脏硬度检测联合FIB-4指数和血清CHI3L1水平预测乙型肝炎肝硬化患者食管静脉曲张效能研究^*[J]. 实用肝脏病杂志, 2026, 29(4): 569-572.

Li Lifang, Wang Chaoyang, Li Zexin. Efficacy of liver stiffness measurement in combination with FIB-4 index and serum CHI3L1 levels in predicting esophageal varices in patients with hepatitis B-induced liver cirrhosis[J]. Journal of Practical Hepatology, 2026, 29(4): 569-572.

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肝脏硬度检测联合FIB-4指数和血清CHI3L1水平预测乙型肝炎肝硬化患者食管静脉曲张效能研究^*

Efficacy of liver stiffness measurement in combination with FIB-4 index and serum CHI3L1 levels in predicting esophageal varices in patients with hepatitis B-induced liver cirrhosis

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