CHB肝硬化患者aMAP评分与HEV之间的相关性分析

The Association between aMAP Score and HEV in Patients with CHB Cirrhosis

目的探讨慢性乙型肝炎肝硬化患者aMAP评分与高危食管静脉曲张(HEV)发生风险之间的关联性。方法选取2017年1月1日至2023年1月1日于安徽医科大学第一附属医院确诊为慢性乙型肝炎肝硬化的患者为研究对象。收集所有研究对象的一般资料,同时收集入院24小时内的实验室检查指标并计算aMAP评分。所有研究对象均完成胃镜检查以评估食管静脉曲张(EV)程度。采用多元Logistic回归评估aMAP评分与HEV风险之间的相关性,采用趋势性检验(P for trend)评估两者之间的相关性是否存在剂量反应关系,最后采用平滑曲线拟合和阈值效应分析明确两者之间是否存在非线性关系。结果最终共纳入患者207例,其中HEV患者104例。与非HEV患者相比,HEV患者aMAP评分更高(P=0.002)。在多个模型中,aMAP评分与HEV之间存在明显的正向相关关系,全调整模型的结果为(OR=1.16,95%CI∶1.03-1.30)。随着aMAP评分的增加,HEV的发生风险也随之增加,趋势性检验具有显著的统计学差异(P for trend<0.01),平滑曲线拟合分析和阈值效应分析提示两者之间为直线效应关系。受试者工作特征曲线(ROC)下面积(AUC)为0.73(0.64-0.78),aMAP评分对HEV诊断的最佳截断值为63.57。结论在慢性乙型肝炎肝硬化患者中,aMAP评分与HEV发病风险之间存在直线性的正性相关关系,并且随着aMAP评分的升高这种正性相关关系更加明显。aMAP评分对HEV具有较好的诊断价值,最佳截断值为63.57。

Objective To investigate the association between aMAP score and the risk of esophageal varices(HEV)in patients with chronic hepatitis B cirrhosis.Methods Patients diagnosed with chronic hepatitis B cirrhosis in our hospital from 2017.1.1 to 2023.1.1 were selected as study subjects.General data of all study subjects were collected,while laboratory examination indexes within 24 hours of admission were collected and aMAP score was calculated.Gastroscopy was completed in all study subjects to assess the extent of esophageal varices(EV).Multiple logistic regression was used to assess the correlation between the aMAP score and the risk of HEV,the trend test(P for trend)was used to assess whether there was a dose-response relationship between the two correlations,and finally,smoothed curve fitting and threshold effect analysis were used to clarify whether there was a nonlinear relationship between the two.Results In the total of 207 patients including 104 HEV patients,the HEV patients'aMAP(P=0.002)scores were higher than that of the non-HEV patients.There was a significant positive correlation between aMAP score and HEV in all models,with the result of the fully adjusted model(OR=1.16,95%CI:1.03-1.30).As the aMAP score increased,the risk of HEV increased with a statistically significant difference in the test for trend(P for trend<0.01),and the smoothed curve fit analysis and the threshold effect analysis suggested a linear effect relationship between the two.The area under the receiver operating characteristic curve(ROC)(AUC)was 0.73(0.64-0.78),and the optimal cutoff value of the aMAP score for HEV diagnosis was 63.57.Conclusions In the patients with chronic hepatitis B cirrhosis,there was a linear positive correlation between aMAP score and the risk of HEV development,more obvious with the increase of aMAP score.The aMAP score has a good diagnostic value for HEV with an optimal cutoff value of 63.57.