ICG15对中或重度肝硬化伴食管胃静脉曲张程度的诊断价值

The clinical significance of liver reserve function for evaluating the severity of esophageal and gastric varices in patients with liver cirrhosis

目的探讨肝脏储备功能、门静脉内径(PVD)在预测肝硬化伴食管胃静脉曲张(esophageal gastric varices,EGV)程度的临床诊断价值。方法回顾性分析曙光医院肝硬化科2018年10月至2020年1月住院治疗肝硬化患者151例的临床资料,所有患者行胃镜检查。将患者分为无或轻度食管胃静脉曲张,中或重度食管胃静脉曲张两组。分析EGV程度与ICG-K、ICG-R15的关系。两组间比较采用t检验或方差分析、秩和检验、χ^(2)检验。采用二元Logistic回归模型分析危险因素。结果无或轻程度的EGV的肝储备功能相关指标中,ICG-R15、PVD、Chid-Pugh-评分、MELD评分、TBil、PT、INR均低于中或重度EGV组,ICG-K值、EHBF、Alb、PLT、APRI评分无或轻程度EGV组大于中或重度EGV组,两组间差异有统计学意义(P<0.05)。其中ICG-K、ICG-R15、PVD、Chid-Pugh-评分是中或重度食管胃底静脉曲张的独立危险因素且EGV严重程度呈正相关(OR值分别为0.003、1.111、1.591、4.669,P值均<0.05),预测无或轻度EGV与中或重的EGV的AUC分别为0.116、0.877、0.773、0.746,进一步分析ICG-R15对诊断中或重度EGV的诊断界值为19.650%,其敏感性特异性分别为0.729、0.955。结论ICG-K、ICG-R15、Chid-Pugh评分与PVD是中或重度EGV的独立危险因素,ICG-R15对预测EGV中或重度分级有较好诊断价值,可作为侵入性胃镜评估的补充参考。

Objective To explore the clinical value of liver reserve function and portal vein diameter(PVD)in predicting the severity of esophageal gastric varices(EGV)in patients with liver cirrhosis.Methods The clinical data of 151 patients with liver cirrhosis were retrospectively analyzed.All patients underwent gastroendoscopic examination.They were then divided into no or mild esophageal varices group,and moderate or severe esophageal varices group referred to the"Trial Scheme for Endoscopic Diagnosis and Treatment of Gastrointestinal Varicose Veins and Bleeding(2009)","BavenoⅥConsensus(2015)","Central Hypertension Esophageal Varicose Hemorrhage Guidelines for Prevention and Treatment(2015).The relationship between the degree of EGV and Indocyanine green elimination rate(ICG-K)and Indocyanine green retention test(ICG-R15)was analyzed.Measurement data that conformed to the normal distribution were expressed as mean±standard deviation(x±s),and the comparison between two groups was performed with T test or analysis of variance.Median and interquartile intervals were used for measurement data that didn’t meet the normal distribution[M(P25~P75)],and the comparison between two groups was performed with the rank sum test.The comparison of count data between groups was performed using theχ^(2) test,and those who did not meet theχ^(2) test conditions used Fisher's exact test.Factor analysis was performed using a binary logistic regression model,and OR values of risk factors and 95%of OR values were calculated.Results Among the indexes related to liver reserve function with no or mild EGV,ICG-R15,PVD,Chid-Pugh-score,model for end-stage liver disease(MELD)score,total bilirubin(Tbil),prothrombin time(PT),and international normalized ratio(INR)were lower than those in the moderate or severe EGV group.ICG-K value,The EHBF,Alb,PLT,and APRI scores of no or mild EGV group were greater than those of moderate or severe EGV group,and the difference between the two groups was statistically significant(P<0.05).Among them,ICG-K,ICG-R15,PVD,Chid-Pugh-scores are independent risk factors for moderate or severe esophageal and gastric varicose veins and the EGV severity is positively correlated(OR values??are 0.003,1.111,1.591,4.669,P values(Both<0.05).The AUC for predicting no or mild EGV and moderate or severe EGV is 0.116,0.877,0.773,0.746,respectively.Further analysis of ICG-R15's diagnostic cutoff value for the diagnosis of moderate or severe EGV is 19.650%,and its sensitivity The specificities were 0.729 and 0.955,respectively.Conclusion Liver reserve function,namely ICG-K,ICG-R15,Chid-Pugh score and PVD are independent risk factors for moderate or severe EGV.ICG-R15 has good diagnostic value for predicting the grade of moderate or severe EGV.It can therefore be used as a supplementary reference for further invasive gastroscopic evaluation.