无创模型对慢性乙型肝炎食管静脉曲张的诊断价值

Noninvasive models value to the diagnosis of esophageal varices in patients with chronic hepatitis B

目的探讨无创模型预测慢性乙型肝炎患者重度食管静脉曲张的诊断价值.方法纳入慢性乙型肝炎患者140例,均行胃镜、血常规、肝功能、凝血四项检查,计算出谷草转氨酶(aspartate transaminase,AST)/谷丙转氨酶(alanine transaminase,ALT)比值(AAR模型)、AST/血小板(platelet,PLT)比值(APRI模型)、谷氨酰转肽酶(glutamyl transferase,GGT)/PLT比值(GPRI模型)、GGT-PLT-ASB比值(S-index模型)、与age-PLT相关的指数(API模型)、age-AST-国际标准化比值(international sensitivity index,INR)-PLT-ALT相关的比值(Fibro-Q模型)、age-AST-INRPLT相关的比值(King模型),利用瞬时弹性测定(Fibroscan)对纳入者肝脏硬度进行测量,食管静脉曲张以内镜诊断为金标准,应用这些数据建立模型进行回顾性研究,数据分析采用受试者工作曲线.结果 AAR、GPRI、S-index、APRI、API、Fibro-Q、King、Fibroscan预测重度食管静脉曲张的曲线下面积分别为0.430、0.800、0.801、0.777、0.612、0.750、0.804、0.890.其中GPRI、S-index、King、Fibroscan预测效能更为显著,敏感度、特异度均较高,相关性较好,Fibroscan预测价值最佳.将Fibroscan与GPRI、S-index、King两两联合后曲线下面积分别为:0.899(P<0.01)、0.892(P<0.01)、0.891(P<0.01).结论这些无创检查中,GPRI、S-index、King、Fibroscan对食管静脉曲张预测具有很好的诊断效能,Fibroscan与GPRI、S-index、King两两联合要比单纯应用Fibroscan预测价值更高,可以作为内镜检查的良好补充和替代方案.

AIM To explore the diagnostic value of noninvasive models for predicting severe esophageal varices in patients with chronic hepatitis B.METHODS A total of 140 patients with chronic hepatitis B were included.All of them underwent endoscopic examination,routine blood tests,liver function tests,and blood coagulation tests.Aspartate transaminase（AST）/ alanine transaminase（ALT）（AAR model） ratio,AST/platelet（PLT） ratio（APRI model）,glutamyl transferase（GGT）/ PLT ratio（GPRI model）,GGT-PLT-ASB ratio（S-index model）,agePLT related index（API model）,age-ASTinternational sensitivity index（INR）-PLTALT ratio（Fibro-Q model）,and age-AST-INRPLT ratio（King model） were evaluated.Upper gastrointestinal endoscopy for esophageal varices was used as the gold standard.The data were used to establish models for receiver operating curve analysis.RESULTS The areas under the curve of AAR,GPRI,S-index,APRI,API,Fibro-Q,King＇s score,and Fibroscan in predicting severe esophageal varices were 0.430,0.800,0.801,0.777,0.612,0.750,0.804,and 0.890,respectively.The prediction performance of GPRI,S-index,King＇s score and Fibroscan was better with regard to higher sensitivity and specificity and better correlation,with Fibroscan performing best.The areas under the combination of Fibroscan and S-index/ King＇s score/ GPRI were 0.899（P〈0.01）,0.892（P〈0.01）,and 0.891（P〈0.01）,respectively.CONCLUSION Noninvasive examinations GPRI,S-index,King＇s score,and Fibroscan have good diagnostic performance for prediction of esophageal varices.Fibroscan combined with S-index/ King＇s/ GPRI has higher predictive value than Fibroscan alone,and can be used as a good alternative to endoscopy.