FibroScan评估慢性乙型肝炎患者食管静脉曲张的效能分析

Efficacy of FibroScan in assessing esophageal varices in patients with chronic hepatitis B

目的探讨Fibro Scan在预测慢性乙型病毒性肝炎(CHB)患者食管静脉曲张(EVs)发生及分级中的临床价值。方法回顾性分析2010年10月-2014年7月于第三军医大学西南医院感染科就诊的563例CHB患者的临床资料,均于2周内行Fibro Scan、胃镜及实验室检查。以受试者工作特征(ROC)曲线及曲线下面积(AUROC)等统计学方法进行效能分析。结果最后入组的396例CHB患者中,肝脏硬度值、血小板、总胆红素、白蛋白与食管静脉曲张程度的相关系数分别为0.605、–0.511、0.523、–0.609。Fibro Scan预测是否存在EVs(G1-G3)、中重度EVs(G2-G3)以及重度EVs(G3)的肝脏硬度临界值分别为9.9、12.2、17.7k Pa,对应的AUROC依次是0.765(P<0.001)、0.884(P<0.001)、0.837(P<0.001)。结论Fibro Scan是一种预测CHB患者食管静脉曲张发生及分度的可靠无创手段,可用于初步筛选是否需行胃镜等检查的患者,但尚不能取代胃镜。

Object To investigate the value of Fibro Scan in predicting the occurrence and grading of esophageal varices（EVs） in patients with chronic hepatitis B（CHB）. Methods The clinical data of 563 CHB patients, who had undergone endoscopy in Southwest Hospital of Third Militar y Medical University, liver stiffness measurement（LSM, measured by Fibro Scan） and laboratory tests from October 2010 to July 2014, were analyzed retrospectively. The receiver operating characteristic（ROC） cur ves and area under ROC（AUROC） were generated to assess the clinical value of Fibro Scan. Results Three hundred and ninety-six patients with CHB were included in our study. The correlation coefficients between LSM, platelet count, total bilirubin, albumin and the grade of EVs were 0.605,-0.511, 0.523,-0.609, respectively. The LSM cutoffs to predict EVs（G1-G3）, EVs（G2-G3）, EVs（G3） were 9.9, 12.2, and 17.7k Pa, respectively, with the sensitivity and specificity over 60%. The corresponding AUROCs were 0.765（P0.001）, 0.884（P0.001）, 0.837（P0.001）, respectively. Conclusions Fibro Scan is a useful and noninvasive tool to predict the presence and grades of EVs in patients with CHB. Though Fibro Scan may not be adequate to replace endoscopy completely, it would be helpful in selecting patients for endoscopic screening.