Predictive value of non-invasive parameter for the degree of esophageal varices in patients with post-hepatitis B cirrhosis
-
摘要:
目的 探讨瞬时弹性成像技术联合血清学指标、肝脏超声检查对食管静脉曲张程度的预测价值，并建立能够预测食管胃底静脉曲张程度的模型。 方法 按胃镜检查结果，将110例乙肝肝硬化失代偿期患者按食管胃底静脉曲张程度分为：无或轻度组，中或重度组。对肝脏硬度值、血小板计数、凝血时间、血清白蛋白水平、脾脏厚度、门静脉直径、肝脏直径进行单因素分析和logistic回归分析，筛选出可以有效预测食管静脉曲张及程度的无创指标，并在此基础上构建预测模型。应用受试者工作特征曲线分析方法评价模型的诊断价值。 结果 建立预测食管静脉曲张程度的回归方程:y=1.07×肝脏硬度值-0.057×血小板计数+0.783×凝血时间+1.876×门脉直径-0.06×脾脏厚度-40.248，ROC曲线下面积为0.979，诊断敏感性为98.7%，特异度为97.1%。 结论 瞬时弹性成像技术检测肝脏硬度值联合血小板计数、凝血时间、门静脉宽度、脾脏厚度等指标建立的无创预测模型预测食管静脉曲张准确、敏感，具有一定的临床应用价值。 Abstract:Objective To analysis the predictive value of transient elastography combined with serum index and liver ultrasound examination for the degree of esophageal varices (EV), and to establish a predictive model for EV. Methods A total of 110 patients with post-hepatitis B cirrhosis were enrolled and divided into two groups according to EV grade assessed by gastroscope: non-EV and grade I group and grade II and III group. The parameters, including liver stiffness (LS), platelet count (PLT), prothrombin time (PT), serum albumin level, the thickness of spleen, the portal vein diameter and the liver diameter were assessed by independent sample T test and binary logistic regression analysis, based on which a predictive model was generated. The receiver operating characteristic(ROC) curve was used to evaluate the accuracy of the model. Results The area under the ROC curve for the model was 0.979. The sensitivity of the model was 98.7% and the specificity was 97.1%. Conclusion The non-invasive model for predicting EV composed of LS and other non-invasive parameters was accurate and sensitive, thus an ideal model for EV prediction in clinic. -
Key words:
- decompensated liver cirrhosis /
- esophageal varices /
- transient elastography /
- non-invasive /
- diagnosis
-
表 1 两组食管静脉曲张患者指标与单因素分析结果（Mean±SD）
变量 例数 肝脏硬度（kPa） 血小板计数（×109/L） 凝血酶原时间（s） 门脉直径（mm） 脾脏厚度（mm） 脾脏直径（mm） 白蛋白（g/L） 轻或无 35 8.94±1.12 147.59±54.39 16.33±2.88 10.42±1.27 5.87±8.68 122.86±17.94 32.25±5.26 中-重度 75 25.08±18.83 89.63±68.05 19.30±2.97 12.64±1.84 51.13±12.31 161.76±15.06 31.77±4.93 t –5.055 4.420 –4.912 –6.469 –2.276 –11.861 P <0.01 <0.01 <0.01 <0.01 0.025 <0.01 0.645 
下载: 导出CSV
表 2 Logistic多因素分析结果
统计量 肝脏硬度（kPa） 血小板计数（×109/L） 凝血酶原时间（s） 门静脉直径（mm） 脾脏厚度（mm） 常数 回归系数 1.07 –0.057 0.783 1.876 –0.006 –40.248 标准误 0.38 0.023 0.361 0.805 0.041 15.917 Wald 7.945 6.123 4.712 5.428 0.02 6.394 P 0.005 0.013 0.03 0.02 0.887 0.011 OR 2.916 0.945 2.188 6.528 0.994 0
下载: 导出CSV
-
[1] Kim DH, Park JY. Prevention and management of variceal hemorrhage[J]. Int J Hepatol, 2013(3): 4346-9. [2] Buechter M, Kahraman A, Manka P, et al. Spleen and liver stiffness is positively correlated with the risk of esophageal variceal bleeding[J]. Digestion, 2016, 94(3): 138-44. doi: 10.1159/000450704 [3] 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血防治指南(2015)[J]. 中华胃肠内镜电子杂志, 2015, 2(4): 1-21. http://news.medlive.cn/liver/info-progress/show-85344_35.html [4] 卢敏, 陈新杰, 黄纯炽, 等. Fibrotouch检测慢性乙型肝炎患者肝脏硬度指标的影响因素分析[J]. 实用医学杂志, 2014, 30(8): 1245-8. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_syyxzz201408020 [5] 方正亚, 张国顺, 刘斌, 等. 肝脏硬度指标对ALT正常慢性乙型肝炎患者肝纤维化的诊断价值[J]. 山东医药, 2017, 57(21): 55-7. doi: 10.3969/j.issn.1002-266X.2017.21.018 [6] 李建志. Fibroscan硬度值测量对乙肝相关肝纤维化的诊断及其与超声影像检查相关性的研究[D]. 济南: 山东大学, 2011. [7] 杨学平. 瞬时弹性成像检测肝脾硬度预测食管静脉曲张的价值[J]. 中国超声医学杂志, 2017(02): 139-42. http://www.cqvip.com/QK/98512X/201603/668242137.html [8] Pár G, Trosits A, Pakodi F, et al. Transient elastography as a predictor of oesophageal varices in patients with liver cirrhosis[J]. Orv Hetil, 2014, 155(7): 270-6. doi: 10.1556/OH.2014.29824 [9] 蓝思荣, 张淼源, 周剑辉. 门静脉高压食管静脉曲张患者超声造影及彩色多普勒参数的检测及意义[J]. 广东医学院学报, 2015, 33(3): 343-5. http://www.cqvip.com/QK/90390A/201503/666532424.html [10] 崔亚云, 王玲, 张超学, 等. 肝超声血流动力学参数评估门静脉高压中重度食管静脉曲张的应用价值[J]. 中华超声影像学杂志, 2013, 22(9): 788-91. [11] Sangma MA, Biswas N, Ahmed MU, et al. Doppler assessment of hepatic venous waves for evaluation of large varices in cirrhotic patient[J]. Mymensingh Med J, 2016, 25(4): 641-6. [12] 赵丹, 毛华, 黄纯炽, 等. 乙型肝炎后肝硬化患者食管静脉曲张发生的无创性预测指标研究[J]. 上海交通大学学报:医学版, 2015, 35(3): 386-90. http://www.cnki.com.cn/Article/CJFDTotal-SHEY201503020.htm [13] 凤辉, 龚镭, 唐学军, 等. 无创血清学肝纤维化评分系统对肝硬化食管胃底静脉曲张的预测价值[J]. 中华消化杂志, 2017, 37(8): 143-7. http://news.medlive.cn/liver/info-progress/show-55337_35.html [14] Bledar, Kraja, Iris, et al. Predictors of esophageal varices and first variceal bleeding in liver cirrhosis patients[J]. World J Gastroenterol, 2017, 23(26): 4806-14. doi: 10.3748/wjg.v23.i26.4806 [15] 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015年版) [J]. 中华实验和临床感染病杂志:电子版, 2015, 9(5): 570-89. http://guide.medlive.cn/guideline/9744 [16] 令孤恩强. 消化道静脉曲张及出血的内镜诊断和治疗规范试行方案[C]//第十届国际治疗内镜及消化病学术会议论文集, 苏州, 2010. [17] Massimo, Bolognesi, Marco, et al. Clinical role of non-invasive assessment of portal hypertension[J]. World J Gastroenterol, 2017, 23(01): 1-10. doi: 10.3748/wjg.v23.i1.1 [18] Ke, Pu, Jing JH, et al. Diagnostic accuracy of transient elastography (Fibro Scan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis[J]. World J Gastroenterol, 2017, 23(02): 345-56. doi: 10.3748/wjg.v23.i2.345 [19] 肝脏硬度评估小组. 瞬时弹性成像技术诊断肝纤维化专家意见[J]. 中华肝脏病杂志, 2013, 21(6): 420-4. http://guide.medlive.cn/guideline/4823 [20] Kitson MT, Kemp WW, Iser DM, et al. Utility of transient elastography in the non-invasive evaluation of cystic fibrosis liver disease[J]. Liver Int, 2013, 33(5): 698-705. doi: 10.1111/liv.12113 [21] Gao L, Meng F, Cheng J, et al. Prediction of oesophageal varices in patients with primary biliary cirrhosis by non-invasive markers[J]. Arch Med Sci, 2017, 13(2): 370-6. http://www.termedia.pl/Journal/-19/pdf-29239-10?filename=prediction%20of%20oesophageal.pdf [22] Sebastiani G, Tempesta D, Fattovich G, et al. Prediction of oesophageal varices in hepatic cirrhosis by simple serum non-invasive markers: Results of a multicenter, large-scale study[J]. J Hepatol, 2010, 53(4): 630-8. doi: 10.1016/j.jhep.2010.04.019 [23] 刘芳, 李庭红, 韩涛, 等. 瞬时弹性成像在肝硬化门静脉高压中的临床评价[J]. 中华肝脏病杂志, 2013, 21(11): 840-4. doi: 10.3760/cma.j.issn.1007-3418.2013.11.010 [24] 徐瀚清, 唐煜文, 杜志娜. 联合检测PVW、SSM、LSM对肝硬化发生胃底静脉曲张出血风险的预测价值[J]. 肝脏, 2017, 22(06): 548-50. doi: 10.3969/j.issn.1008-1704.2017.06.022 [25] 李勤涛, 蒋力, 张珂, 等. 无创模型预测肝炎肝硬化患者食管静脉曲张[J]. 中华肝脏病杂志, 2015, 23(5): 339-42. http://d.wanfangdata.com.cn/Periodical_zhgzbzz201505004.aspx [26] 王晓彤, 韩涛, 李雅玥. 无创血清学模型对酒精性肝硬化食管静脉曲张的预测价值[J]. 山东医药, 2016, 56(8): 4-6. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_shandyy201608002 [27] Castera L, Pinzani M, Bosch J. Non invasive evaluation of portal hypertension using transient elastography[J]. J Hepatol, 2012, 56(3): 696-703. doi: 10.1016/j.jhep.2011.07.005 -
点击查看大图
图(1) / 表(2)
计量
- 文章访问数: 1610
- HTML全文浏览量: 601
- PDF下载量: 6
- 被引次数: 0
