吲哚菁绿清除试验对乙型肝炎肝硬化患者发生食管胃底静脉曲张的预测价值

Predictive accuracy of indocyanine green clearance test for the development of esophagogastric varices in patients with hepatitis B cirrhosis

目的:探讨吲哚菁绿清除试验及血清学指标对乙型肝炎肝硬化患者发生食管胃底静脉曲张(EGV)的预测价值,并建立发生EGV的预测模型。方法:采用前瞻性研究,纳入2021年3月至2022年3月广东省中医院肝病科的乙型肝炎肝硬化患者87例,所有患者均行胃镜检查及吲哚菁绿清除试验。根据胃镜结果将患者分为无EGV组(26例)和有EGV两组(61例)。采用二元Logistic回归模型分析危险因素,并筛选出可以有效预测EGV的无创指标,在此基础上构建预测模型。应用受试者工作特征曲线(ROC曲线)评价模型的诊断效能。结果:无EGV组患者的血小板计数(PLT)、Alb、Cr、吲哚菁绿清除率(ICG-K)均高于有EGV组(P<0.05),而AST、TBil、PT、INR、吲哚菁绿15 min滞留率(ICG-R15)均低于有EGV组(P<0.05)。其中ICG-R15和PLT是发生EGV的独立危险因素,且ICG-R15与EGV的风险呈正相关(OR=87.156,P<0.05),而PLT呈负相关(OR=0.984,P<0.05)。ICG-R15诊断EGV患者的临界值、敏感度、特异度及AUC分别为0.176、75.4%、80.8%及0.789;ICG-R15联合PLT诊断EGV患者的临界值、敏感性、特异性及AUC分别为0.705、78.7%、76.9%及0.84。结论:ICG-R15和PLT是EGV的独立危险因素,ICG-R15联合PLT对预测乙型肝炎肝硬化患者发生EGV具有一定参考价值,可作为胃镜检查的补充手段。

Objective:To explore the predictive value of indocyanine green clearance test(ICG)and serological indicators for esophageal and gastric varices(EGV)in patients with hepatitis B cirrhosis,and to establish a model that can predict the occurrence of esophageal and gastric varices.Methods:This prospective study included 87 patients with hepatitis B cirrhosis in the Department of Hepatology of Guangdong Hospital of Traditional Chinese Medicine from March 2021 to March 2022.All patients underwent gastroscopy and indocyanine green clearance test.According to the results of gastroscopy,the patients were divided into two groups without EGV(26 cases)and with EGV(61 cases).Binary Logistic regression model was used to analyze the risk factors and screen out the non-invasive indicators that could effectively predict EGV,and then the prediction model was constructed.Receiver operating characteristic curve(ROC curve)was used to evaluate the diagnostic efficiency of the model.Results:The PLT,ALB,Cr,and ICG-K levels in the non varicose group were higher than those in the varicose group(P<0.05),while AST,TBIL,PT,INR,and ICG-R15 levels were lower than those in the varicose group(P<0.05),and the differences between the two groups were statistically significant.Among them,ICG-R15 and PLT were independent risk factors for esophageal and gastric varices,and ICG-R15 was positively correlated with the risk of EGV[OR=87.156,P<0.05],while PLT was negatively correlated[OR=0.984,P<0.05].Both have statistical differences.Further analysis showed that the critical values,sensitivity,specificity and AUC of ICG-R15 for diagnosing EGV patients were 0.176,75.4%,80.8%and 0.789,respectively.The critical value,sensitivity specificity,and AUC of ICG-R15 and PLT for diagnosing EGV patients with PLT+1.786 were 0.705,78.7%,76.9%and 0.84,respectively.Conclusion:ICG-R15 and PLT are independent risk factors of EGV.ICG-R15 combined with PLT has certain reference value in predicting the occurrence of EGV in patients with hepatitis B cirrhosis,and can be used as a supplementary means of gastroscopy.