肝纤维化无创检测指标对肝硬化代偿期患者食管静脉曲张的预测价值

The predictive value of non-invasive detection indexes of liver fibrosis to esophageal varices in the compensated stage of liver cirrhosis

目的:探讨肝脏硬度值(LSM)及以血液学指标为参数的诊断模型如APRI、FIB-4、GPR对肝硬化患者食管静脉曲张(GOV)的预测价值。方法:收集2015年1月至2020年1月我科收治的119例肝硬化代偿期患者的临床资料,按胃镜检测结果将119例患者分为4组:无GOV组43例,轻度GOV组35例,中度GOV组23例,重度GOV组18例。分析4组患者的肝功能及LSM变化并计算APRI、FIB-4、GPR值,分析这些指标与GOV的相关性,绘制受试者工作特征(ROC)曲线,根据ROC曲线下的面积(AUC)评价LSM、APRI、FIB-4、GPR以及LSM与FIB-4联合检测对肝硬化GOV的诊断价值。结果:①肝硬化患者GOV严重程度与LSM、APRI、FIB-4、GPR均呈正相关性(P<0.05)。②GOV轻、中度患者LSM、GPR、APRI、FIB-4的ROC曲线下面积分别为0.71、0.73、0.70、0.74;GOV中、重度患者LSM、GPR、APRI、FIB-4的ROC曲线下面积分别为0.74、0.78、0.79、0.83。③LSM与FIB-4联合检测时ROC曲线下面积分别为0.78、0.84。结论:LSM、APRI、FIB-4、GPR预测肝硬化患者GOV有一定的临床价值,LSM与FIB-4联合检测未能体现出更高的诊断水平。

Objective:To explore liver stiffness measurement(LSM)and diagnostic models with hematological parameters as parameters such as APRI,FIB-4,GPR has predictive value for esophageal varices of liver cirrhosis.Methods:The patients with compensated liver cirrhosis who were admitted to the Department of Hepatology,Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from January 2015 to January 2020 were collected for blood routine,liver function,Fibro Touch examination,electronic gastroscopy,and APRI,FIB-4 and GPR were calculated.Analysis of variance was used for the comparison of measurement data conforming to normal distribution among multiple groups,while Kruskal-Wallis H test was used for measurement data not conforming to normal distribution.Pearson was used for correlation analysis.Using the diagnostic results of electronic gastroscopy as the gold standard,the ROC curve was drawn,and the diagnostic value of LSM,APRI,FIB-4,GPR,and the combined detection of LSM and FIB-4 for hepatic cirrhosis of esophageal varices was evaluated according to the area under the ROC curve(AUC).Results:①The severity of esophageal varices in cirrhosis was positively correlated with LSM,APRI,FIB-4,and GPR(P<0.05).②The areas under the ROC curve of LSM,GPR,APRI,and FIB-4 in the mild to moderate esophageal varices group were 0.71,0.73,0.70,and 0.74.The areas under the ROC curve of LSM,GPR,APRI,and FIB-4 in the moderate to severe esophageal varices group were 0.74,0.78,0.79,and 0.83.③The area under the ROC curve of the two groups was 0.78 and 0.84,respectively,for the combined detection of LSM and FIB-4.Conclusion:This study shows that LSM,APRI,FIB-4,and GPR have a certain clinical value in predicting cirrhosis of cirrhosis.The combined test fails to reflect the better diagnostic value.