实时组织弹性成像与实验室检查指标诊断肝癌肝硬化患者食管静脉曲张的比较

Comparison of real-time tissue elastography and laboratory tests in evaluating esophageal varices of patients with liver cancer and cirrhosis

目的比较实时组织弹性成像(RTE)与实验室检查对肝癌肝硬化患者食管静脉曲张(EV)的诊断效能。方法对111例肝癌肝硬化患者分别行超声检查、实验室检查和胃镜检查。超声检查获得肝纤维化指数(LFI);实验室检查记录天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、血小板(PLT)水平,计算天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AAR)、天门冬氨酸氨基转移酶/血小板比值指数(APRI)。以胃镜检查结果为金标准,将EV程度分为无EV(EV0)、轻度(EV1)、中度(EV2)、重度(EV3),并进行统计学分析。结果EV0与EV≥1患者的LFI、AST、PLT、APRI差异均有统计学意义(P均<0.05),年龄、性别比、ALT和AAR差异均无统计学意义(P均>0.05)。EV≤1与EV≥2患者的LFI、PLT、AAR、APRI差异均有统计学意义(P均<0.05),年龄、性别比、AST和ALT差异均无统计学意义(P均>0.05)。EV程度与LFI、PLT、APRI呈中度相关(r=0.49、-0.49、0.49,P均<0.01);EV程度与AST呈低度正相关(r=0.24,P<0.01);EV程度与ALT及AAR无相关性(r=0.11、0.20,P均>0.05)。LFI和AST诊断EV≥1的曲线下面积差异有统计学意义(P=0.02);LFI、AAR、APRI和PLT诊断EV≥2的AUC两两比较,差异均无统计学意义(P均>0.05)。结论 LFI、PLT、APRI及AAR诊断EV≥1和EV≥2有一定价值。

Objective To compare the diagnostic efficacy of real-time tissue elastography （RTE） with laboratory tests in diagnosis of liver Cancer with cirrhosis esophageal varices （EV）. Methods Ultrasonography, laboratory tests and gastroscope were performed in 111 liver cancer patients with cirrhosis respectively. Liver stiffness index （LFI） was obtained. Moreover, the level of aspartate aminotransferase （AST）, alanine aminotransferase （ALT）, platelet （PLT） was recorded. The ratio of AST and ALT （AAR）, and the ratio of AST and PLT （APR1） were calculated. Taking the results of gastro- scope examination as golden standard, EV level was devided into 4 grades： No varices （EV0）, small and straight EV （EV1）, enlarged and tortuous EV （EV2） and large, coil-shaped EV （EV3）, and statistical analysis was performed. Results There were significant difference in LFI, AST, PLT and APRI between EV0 and EV≥1 patients （all P〈0.05）, but no significant differences in age, sex ratio, ALT and AAR （all P〉0.05）. There were significant difference in LFI, PLT, AAR and APRI between EVil and EV≥2 patients （all P〈0.05）, but no significant difference in age, sex ratio, AST and ALT （all P〉0.05）. The degree of EV had moderate correlation with LFI, PLT, APRI （r=0.49, -0.49, 0.49, all P〈0.01）. The degree of EV had weak positive correlation with AST （r=0.24, P〈0.01）. The degree of EV had no correlation with ALT and AAR （r= 0.11, 0.20, both P〉0.05）. There were significant difference between LFI ar- ea under ROC （AUC） and AST AUC in diagnosis of EVil （P=0.02）. AUC of LFI, AAR, APRI and PLT by pairwise comparison all had no significant difference in diagnosis of EV≥2 （all P 〉0.05）. Conclusion LFI, PLT, APRI and AAR have certain value in diagnosis of EVil and EV≥2.