摘要
目的评估脾脏硬度对肝硬化患者食管静脉曲张(EV)的预测价值。资料与方法回顾性分析80例慢性乙肝肝硬化患者的胃镜检查、Fibro Touch检查与血清学检查资料。以胃镜检查结果为“金标准”,将患者分为EV组和非EV组,比较两组患者肝脏硬度值(LSM)和脾脏硬度值(SSM);计算纤维化4项指标(FIB-4)、天冬氨酸氨基转移酶与血小板比率指数(APRI);探讨4项指标的相关性,并比较SSM、LSM单独及与血清学指标联合预测EV的价值。结果66例EV组患者LSM、SSM、APRI、FIB-4明显高于14例非EV组,差异均有统计学意义(P<0.05)。SSM与LSM、APRI、FIB-4均呈正相关(r=0.680、0.415、0.227,P<0.05)。Logistic回归分析结果显示,仅SSM是预测EV的影响因素(P=0.001)。LSM、SSM、FIB-4、APRI预测EV的受试者工作特征曲线下面积(AUC)分别为0.816、0.880、0.733、0.732。SSM的AUC显著大于FIB-4和APRI(P<0.05),但与LSM相比差异无统计学意义(P>0.05)。联合指标LSM+FIB-4、LSM+APRI、SSM+APRI、SSM+FIB-4预测EV的AUC分别为0.832、0.832、0.878、0.887。SSM+FIB-4联合诊断模型的AUC最高,显著高于单项血清学指标(P<0.05),但与LSM、SSM及其他联合指标比较差异无统计学意义(P>0.05)。结论应用Fibro Touch测量SSM可有效预测慢性乙肝肝硬化患者EV的存在,其预测价值与LSM相似。
Purpose To evaluate the value of spleen stiffness measurement in predicting esophageal varices(EV)of patients with cirrhosis.Materials and Methods Gastroscopy,Fibro Touch and serological examination of 80 patients with chronic hepatitis B cirrhosis were retrospectively analyzed.The results of endoscopy were used as the“gold standard”,all patients were divided into EV group and non-EV group.Liver stiffness measurement(LSM)and spleen stiffness measurement(SSM)were compared between the two groups.The fibrosis index based on factor 4(FIB-4)and aspartate aminotransferase and platelet ratio index(APRI)were calculated.The correlation of the four indexes was discussed.Then the predictive value of SSM and LSM,alone or in combination with serological indicators were compared.Results The LSM,SSM,APRI and FIB-4 in EV group(n=66)were significantly higher than those in non-EV group(n=14)(P<0.05).SSM was positively correlated with LSM,APRI and FIB-4(r=0.680,0.415 and 0.227,P<0.05).Logistic regression analysis showed that SSM was the only influencing factor for EV prediction(P=0.001).The area under the receiver operating characteristic curve(AUC)of LSM,SSM,FIB-4 and APRI were 0.816,0.880,0.733 and 0.732,respectively.The AUC of SSM was higher than that of FIB-4 and APRI(P<0.05),but the difference was not statistically significant compared with LSM(P>0.05).The AUC of the combined indicator LSM+FIB-4,LSM+APRI,SSM+APRI and SSM+FIB-4 were 0.832,0.832,0.878,0.887,respectively.The AUC of SSM+FIB-4 combined diagnostic model was the highest,significantly higher than that of single serological index(P<0.05),but there was no significant difference with LSM,SSM or other three combined indexes(P>0.05).Conclusion SSM measured by Fibro Touch has good clinical value in predicting the presence of EV in patients with chronic hepatitis B cirrhosis,and its predictive value is similar to that of LSM.
作者
左辉兰
刘婷
李田
杨舒婷
高峰
ZUO Huilan;LIU Ting;LI Tian;YANG Shuting;GAO Feng(Department of Ultrasound,the Third Xiangya Hospital of Central South University,Changsha 410013,China)
出处
《中国医学影像学杂志》
CSCD
北大核心
2021年第1期51-55,共5页
Chinese Journal of Medical Imaging
基金
湖南省自然科学基金(2018JJ2604)。
关键词
肝硬化
肝炎
乙型
食管和胃静脉曲张
弹性成像技术
血清学试验
预测
Liver cirrhosis
Hepatitis B
Esophageal and gastric varices
Elasticity imaging techniques
Serologic tests
Prediction
