无创血清学模型对酒精性肝硬化食管静脉曲张的预测价值

Predictive value of non-invasive serum models in assessment of esophageal varices in patients with alcoholic liver cirrhosis

目的探讨无创血清学模型中红细胞体积分布宽度(RDW)与血小板比值(RPR)、γ-谷氨酰转移酶(GGT)与血小板比值指数(GPRI)、S指数、基于4因子的肝纤维化指标(FIB-4)、AST与血小板比值指数(APRI)对酒精性肝硬化食管静脉曲张的预测价值。方法选择酒精性肝硬化患者126例,其中伴轻中度静脉曲张者20例(轻中度组)、重度静脉曲张者67例(重度组),无静脉曲张者39例(无曲张组)。收集各组血常规(RDW、PLT)、肝功能(ALT、AST、GGT、ALB)指标,计算RPR、GPRI、S指数、FIB-4、APRI。采用受试者工作特征曲线分析4种指标对食管静脉曲张的预测价值。结果重度组RPR、GPRI、S指数、FIB-4、APRI均高于轻中度组、无曲张组(P均<0.05)。而轻中度组与无曲张组各指标比较差异均无统计学意义(P均>0.05)。RPR、GPRI、S指数、FIB-4预测食管静脉曲张的曲线下面积(AUC)分别为0.902、0.828、0.960、0.883、0.799,预测重度食管静脉曲张的AUC分别为0.891、0.782、0.836、0.816、0.762。结论无创血清学模型中RPR、GPRI、S指数、FIB-4、APRI对预测酒精性肝硬化伴食管静脉曲张及其严重程度具有一定参考价值,可作为非侵入性评估方法。

Objective To investigate the predictive value of red cell volume distribution width（ RDW） to platelet ratio（ RPR）,γ-glutamyltransferase to platelet ratio index（ GPRI）,S-index,fibrosis index based on the 4 factor（ FIB-4） and aspartate aminotransferase（ AST） to platelet ratio index（ APRI） in the non-invasive serum models in assessing esophageal varices in patients with alcoholic liver cirrhosis. Methods Totally 126 patients with alcoholic liver cirrhosis including 20 cases of patients complicated with mild and moderate esophageal varices（ mild and moderate group）,67 cases of severe esophageal varices（ severe group） and 39 cases of non-esophageal varices（ non-varices group） were enrolled. Blood routine（ RDW and PLT） and liver function（ ALT,AST,GGT and ALB） were tested,and RPR,GPRI,S-index,FIB-4,APRI were calculated. Receiver operating characteristic（ ROC） curves and the areas under the curves（ AUCs） were calculated to assess the performance of these models in predicting esophageal varices. Results RPR,GPRI,S-index,FIB-4 and APRI in the severe group were higher than those of the mild and moderate group and non-varices group（ all P 0. 05）; and no significant differences were found in the above indexes between the mild and moderate group and non-varices group（ all P 0. 05）. The AUCs of RPR,GPRI,S index and FIB-4 in predicting esophageal varices were respectively 0. 902,0. 828,0. 960,0. 883 and 0. 799; AUCs of RPR,GPRI,S index and FIB-4 in predicting severe esophageal varices were respectively 0. 891,0. 782,0. 836,0. 816 and 0. 762. Conclusion RPR,GPRI,S-index,FIB-4 and APRI in the non-invasive serum models are of clinical value in assessing the presence and severe degrees of esophageal varices in patients with alcoholic liver cirrhosis and can be used as the non-invasive assessment methods.