FibroScan联合无创血清指标对乙型肝炎肝硬化患者食管静脉曲张程度的预测价值

Predictive value of FibroScan combined with non-invasive serum indicators for the degree of esophageal varices in patients with hepatitis B cirrhosis

目的探讨超声瞬时弹性检测(FibroScan)、无创血清学指标以及这些指标的联合应用对乙型肝炎肝硬化患者食管静脉曲张程度的预测价值。方法以胃镜结果作为金标准,对494例乙型肝炎肝硬化患者食管静脉曲张程度分为:无或轻度曲张组和中或重度曲张组,分别评价FibroScan、APRI、LOK评分及FibroScan联合APRI和FibroScan联合LOK对食管静脉曲张程度的诊断效率。结果 FibroScan、APRI、LOK评分及FibroScan联合APRI和FibroScan联合LOK在上诉两组患者中比较,差异均有统计学意义(P<0.05),在预测食管静脉曲张程度时,APRI的AUROC值为0.76;LOK评分的AUROC值为0.81;FibroScan的AUROC值为0.88,FibroScan联合APRI的AUROC值为0.89;FibroScan联合LOK的AUROC值为0.93,当cut-off值为21时,其灵敏性为93%,特异性为90%。FibroScan联合LOK评分是诊断效率最高的。结论 FibroScan联合无创血清学指标可以提高对乙型肝炎肝硬化患者食管静脉曲张程度的诊断效率,其中FibroScan联合LOK评分预测食管静脉曲张程度的灵敏性为93%,特异性为90%,具有一定的临床应用价值。

Objective To analyze the predictive value of transient elastography(FibroScan), AST-to-platelet ratio index(APRI), LOK score or combined with serum index and FibroScan examination for the degree of esophageal varices in patients with hepatitis B cirrhosis. Methods According to the results of gastroscopy, 494 patients with hepatitis B cirrhosis were divided into two groups: no or mild varices group and moderate or severe varices group. The diagnostic efficiency of FibroScan, APRI, LOK score, FibroScan combined with APRI and FibroScan combined with LOK for the degree of esophageal varices was evaluated, respectively. Results FibroScan, APRI, LOK scores, FibroScan combined with APRI and FibroScan combined with LOK were significantly different between two groups(P<0.05). When predicting the degree of esophageal varices, the AUROC of APRI was 0.76;the AUROC of LOK score was 0.81;the AUROC of FibroScan was 0.88;and the AUROC of FibroScan combined with APRI was 0.89;The AUROC of FrioScan combined with LOK was 0.93. When FrioScan combined with LOK cut-off value was 21, its sensitivity was 93% and specificity was 90%. Conclusion FibroScan combined with non-invasive serological indicators can improve the diagnostic efficiency of esophageal varices in patients with hepatitis B cirrhosis. The sensitivity is 93% and specificity is 90% and it has certain clinical value when FibroScan combined with LOK score predicting the degree of esophageal varices.