几种非侵入性肝纤维化评分系统在肝硬化并食管胃底静脉曲张破裂出血组与非出血组间的比较

Comparison of several non-invasive liver fibrosis scoring systems between liver cirrhosis with esophagogastric varices bleeding group and non-bleeding group

目的探讨APRI、GPR、FIB-5、S-index、AAR、GAPRI在肝硬化并食管胃底静脉曲张破裂出血组与非出血组间的差异。方法将2017年1月1日至2019年11月1日于武汉大学人民医院住院的206例肝硬化并食管胃底静脉曲张患者分为非出血组和出血组,收集两组患者的临床资料、辅助检查结果,回顾性分析APRI、GPR、FIB-5、S-index、AAR、GAPRI在两组之间的差异。结果出血组患者WBC、NEU%、NEU、RDW-CV水平高于非出血组,非出血组患者AST、GGT、ALP、ALB水平高于出血组,差异有统计学意义(P<0.05)。PLT、RDW-SD、ALT水平在两组之间差异无统计学意义(P>0.05)。二元Logistic回归分析提示,NEU%是肝硬化并食管胃底静脉曲张患者发生曲张静脉破裂出血的独立危险因素,而ALB、ALP是其保护因素。出血组S-index、GAPRI、GPR水平低于非出血组(P<0.05),APRI、AAR在两组之间差异无统计学意义(P>0.05)。结论S-index、GAPRI、GPR水平较低的肝硬化并食管胃静脉曲张患者可能易发生曲张静脉破裂出血,需引起临床医师的重视,而APRI、AAR值可能对曲张静脉是否发生破裂出血无影响。

Objective To investigate whether APRI, GPR, FIB-5, S-index, AAR and GAPRI are different between esophagogastric varices bleeding group and non-bleeding group.Methods A total of 206 patients with liver cirrhosis and esophagogastric varices hospitalized in the Renmin Hospital of Wuhan University from Jan. 1 st, 2017 to Nov. 1 st, 2019 were enrolled and divided into non-bleeding group and bleeding group. The clinical data and auxiliary examination results of two groups were collected and made a retrospective analysis of differences in APRI, GPR, FIB-5, S-index, AAR, and GAPRI between two groups. Results The levels of WBC, NEU%, NEU, and RDW-CV in the bleeding group were higher than those in the non-bleeding group, and the levels of AST, GGT, ALP, and ALB in the non-bleeding group were higher than those in the bleeding group(P<0.05). The levels of PLT, RDW-SD and ALT were not statistically different between the two groups(P>0.05). Binary Logistic regression analysis suggested that NEU% was an independent risk factor for esophagogastric varices bleeding in patients with liver cirrhosis and esophagogastric varices, while ALB and ALP were its protective factors. The levels of S-index, GAPRI and GPR in the bleeding group were lower than those in the non-bleeding group(P<0.05). There was no difference on level of APRI and AAR between two groups(P>0.05). Conclusion Patients with gastroesophageal varices who with low levels of S-index, GAPRI, and GPR may be more likely to experience esophagogastric varices bleeding, which needs to be paid attention by clinicians, and APRI and AAR values may have no effect on whether varicose veins will rupture and bleed.