多种无创性模型预测乙型肝炎肝硬化患者食管静脉曲张程度的价值研究

Value of multiple noninvasive models in predicting the degree of esophageal varices in patients with hepatitis B cirrhosis

目的 :比较MSCT测得的脾脏体积、天冬氨酸转氨酶(AST)与血小板(PLT)比值指数(APRI)及AST与丙氨酸转氨酶(ALT)比值(AAR)对肝硬化食管静脉曲张及其分级的诊断价值。方法:根据上消化道内镜结果将108例慢性乙型肝炎肝硬化患者分为食管静脉曲张组(47例)和无食管静脉曲张组(61例);2组临床指标比较行t检验或χ~2检验;相关指标(PLT、ALT、脾脏体积、APRI、AAR)与食管静脉曲张分级的关系采用Spearman相关性分析;分析相关指标(PLT、ALT、脾脏体积、APRI、AAR)诊断有无食管静脉曲张及其分级的临界值,并计算ROC的AUC。结果:2组PLT、ALT、脾脏体积、APRI、AAR比较,差异均有统计学意义(均P<0.05);ALT、脾脏体积、APRI与食管静脉曲张分级呈正相关(r=0.249、0.703、0.320;均P<0.05);PLT、AAR均与食管静脉曲张分级呈负相关(r=-0.389、-0.268;均P<0.05);脾脏体积诊断有食管静脉曲张、中度及重度食管静脉曲张ROC曲线的AUC分别为0.886、0.781、0.816(均P<0.001)。结论:PLT、ALT、脾脏体积、APRI、AAR与乙型肝炎肝硬化患者并发食管静脉曲张密切相关;与PLT、ALT、APRI、AAR相比,脾脏体积能更好诊断和区分乙型肝炎肝硬化患者的食管静脉曲张及其分级。

Objective:To compare the diagnostic value of spleen volume measured by MSCT,AST and platelet(PLT) ratio index(APRI) and AST to ALT ratio(AAR) for the classification of esophageal varices in patients with hepatitis B cirrhosis.Methods:According to the results of upper gastrointestinal endoscopy,the patients were divided into esophageal varices group(47 cases) and no esophageal varices group(61 cases),and the clinical indexes of the two groups were compared by t or χ~2 test.The correlation between the relevant indicators(PLT,ALT,spleen volume,APRI and AAR) and the classification of esophageal varices was performed by Spearman correlation analysis,further ROC curve analysis was used to diagnose and differentiate the classification of esophageal varices.Results:The PLT,ALT,spleen volume,APRI and AAR in between the two groups were significantly different(all P<0.05).Furthermore ALT,spleen volume and APRI were positively correlated with the classification of esophageal varices(r=0.249,0.703,0.320,all P<0.05),but PLT and AAR were negatively correlated with the classification of esophageal varices(r=-0.389,-0.268,both P <0.001),and the area under the ROC curve for spleen volume diagnosis and differentiation of esophageal varices,moderate esophageal varices,and severe esophageal varices were 0.886,0.781,and 0.816,respectively(all P <0.001).Conclusions:PLT,ALT,spleen volume,APRI,AAR are closely related to esophageal varices in patients with hepatitis B cirrhosis.Compared with PLT,ALT,APRI and AAR,spleen volume can better diagnose and differentiate the classification of esophageal varices in patients with hepatitis B cirrhosis.