PLT计数、FIB-4、APRI与肝硬化食管静脉曲张发生及严重程度的相关性分析

王报; 牛俊奇

doi:10.3969/j.issn.1001-5256.2018.01.017

PLT计数、FIB-4、APRI与肝硬化食管静脉曲张发生及严重程度的相关性分析

DOI: 10.3969/j.issn.1001-5256.2018.01.017

王报,
牛俊奇

吉林大学白求恩第一医院肝胆胰内科

详细信息

中图分类号: R575.2
计量
- 文章访问数: 462
- HTML全文浏览量: 44
- PDF下载量: 154
- 被引次数: 0
出版历程
- 出版日期: 2018-01-20

Association of platelet count, fibrosis-4, and aspartate aminotransferase-to-platelet ratio index with the development and severity of esophageal varices in patients with liver cirrhosis

Wang Bao,
Niu JunQi

Department of Hepatology, The First Hospital of Jilin University, Changchun 130021, China

摘要

摘要:
目的探讨PLT计数及基于4因子的肝纤维化指标（FIB-4）、AST/PLT比值指数（APRI）在预测肝硬化患者食管静脉曲张（EV）发生及分级中的临床价值。方法回顾性分析2012年1月-2015年12月就诊于吉林大学第一医院肝胆胰内科的163例肝硬化患者的临床资料。所有患者均于入院1周内行上消化道内镜检查。依据PLT计数将入选患者分为4组,PLT≤50×109/L组27例,50×109/L至≤100×109/L组84例,100×109/L至≤150×109/L组26例,PLT计数>150×109/L组26例;并记录ChildPugh评分及FIB-4、APRI,分析PLT计数及FIB-4、APRI与EV的关系。符合正态分布的计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验,不符合正态分布的计量资料多组间比较采用Kruskall-Wallis H检验,进一步两两比较采用Dunn-Bonferroni检验;计数资料组间比较采用χ
- 肝硬化 /
- 食管和胃静脉曲张 /
- 血小板 /
- 诊断
Abstract:
Objective To investigate the clinical value of platelet count ( PLT) , fibrosis-4 ( FIB-4) , and aspartate aminotransferase-to-platelet ratio index ( APRI) in predicting the development and classification of esophageal varices ( EVs) . Methods A retrospective analysis was performed for the clinical data of 163 patients with liver cirrhosis who visited Department of Hepatology in The First Hospital of Jilin University from January 2012 to December 2015. All patients underwent upper gastrointestinal endoscopy within one week after admission. According to PLT, the patients were divided into PLT ≤50 × 109/L group with 27 patients, PLT 50 × 109/L-≤100 × 109/L group with 84 patients, PLT 100 × 109/L-≤150 × 109/L group with 26 patients, and PLT > 150 × 109/L group with 26 patients. The Child-Pugh score, FIB-4, and APRI were recorded, and the association of PLT, FIB-4, and APRI with EVs was analyzed. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the LSD-t test was used for further comparison between any two groups; the Kruskall-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Dunn-Bonferroni test was used for further comparison between any two groups. The chi-square test was used for comparison of categorical data between groups, and the Fisher's test was used for the data which did not meet the conditions of the chi-square test. Spearman rank correlation was used to investigate the correlation of PLT, FIB-4, and APRI with EVs. The receiver operating characteristic ( ROC) curve and the area under the ROC curve ( AUC) were used to evaluate the values of PLT, FIB-4, and APRI in the diagnosis of EVs. Results Of all 163 patients with liver cirrhosis, 114 developed EVs and 49 did not experience EVs. There was a significant difference in the incidence rate of EVs between the cirrhotic patients with different PLTs ( χ2= 27. 36, P < 0. 001) . Compared with those with PLT≤150 × 109/L, the cirrhotic patients with PLT > 150 × 109/L had a significantly lower proportion of patients with EVs ( 34. 6% vs 76. 6% , P < 0. 001) or severe EVs ( 3. 8% vs 46. 7% , P < 0. 001) . There were significant differences in FIB-4 and APRI between the patients with different PLTs ( χ2= 102. 58 and 57. 02, both P < 0. 001) . PLT was negatively correlated with the degree of EVs ( r =-0. 491, P < 0. 001) , and FIB-4 and APRI were positively correlated with the degree of EVs ( r = 0. 460 and 0. 325, both P<0. 651="" 676="" 732="" 739="" 742="" 763="" .="" plt="" had="" an="" auc="" of="" 0.="" and="" accuracy="" 75.="" in="" predicting="" the="" presence="" or="" absence="" while="" fib-4="" 71.="" apri="" 72.="" 69.="" severe="" 67.="" 66.="" conclusion="" cirrhotic="" patients="" with="">150 × 109/L have a significant reduction in the risk of EVs or severe EVs. PLT, FIB-4, and APRI are correlated with the degree of EVs in cirrhotic patients, but they cannot fully replace gastroscopy.
- liver cirrhosis /
- esophageal and gastric varices /
- blood platelets /
- diagnosis

HTML全文

参考文献(14)

[1] Chinese Society of Digestive and Chinese Society of Hepatology Diseases, Chinese Society of Endoscopology, Chinese Medical Association.Prevention and management of gastroesophageal variceal hemorrhage in cirrhosis (2008, Hangzhou) [J].Chin J Infect Dis, 2008, 28 (8) :551-558. (in Chinese) 中华医学会消化病学分会, 中华医学会肝病学分会, 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的防治共识 (2008, 杭州) [J].中华消化杂志, 2008, 28 (8) :551-558.

[2]MALLET V, DHALLUIN-VENIER V, ROUSSIN C, et al.The accuracy of the FIB-4 index for the diagnosis of mild fibrosis in chronic hepatitis B[J].Aliment Pharmacol Ther, 2009, 29 (4) :409-415.

[3]WAI CT, GREENSON JK, FONTANA RJ, et al.A simple noninvasive index can predict both signifcant fbrosis and cirrhosis in patients with chronic hepatitis C[J].Hepatology, 2003, 38 (2) :518-526.

[4]PENG Y, QI XS, GUO XZ.Report of the BavenoⅥConsensus Workshop:stratifying risk and individualizing care for portal hypertension[J].J Clin Hepatol, 2015, 31 (8) :1202-1207. (in Chinese) 彭颖, 祁兴顺, 郭晓钟.2015年BavenoⅥ共识:门静脉高压的风险分层及个体化管理[J].临床肝胆病杂志, 2015, 31 (8) :1202-1207.

[5]ABBASI A, BUTT N, BHUTTO AR, et al.Correlation of thrombocytopenia with grading of esophageal varices in chronic liver disease patients[J].J Coll Phys Surg Pakistan, 2010, 20 (6) :369-372.

[6]GIANNINI E, BOTTA F, BORRO P, et al.Platelet count/spleen diameter ratio:proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis[J].Gut, 2003, 52 (8) :1200-1205.

[7]BARRERA F, RIQUELME A, SOZA A, et al.Platelet count/spleen diameter ratio for non-invasive prediction of high risk esophageal varices in cirrhotic patients[J].Ann Hepatol, 2009, 8 (4) :325-330.

[8]SCHEPIS F, CAMMA C, NICEFORO D, et al.Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection?[J].Hepatology, 2001, 33 (2) :333-338.

[9]TAFAREL JR, TOLENTINO LH, CORREA LM, et al.Prediction of esophageal varices in hepatic cirrhosis by noninvasive markers[J].Eur J Gastroenterol Hepatol, 2011, 23 (9) :754-758.

[10]WANG JH, CHUAH SK, LU SN, et al.Transient elastography and simple blood markers in the diagnosis of esophageal varices for compensated patients with hepatitis B virus-related cirrhosis[J].J Gastroenterol Hepatol, 2012, 27 (7) :1213-1218.

[11]DENG H, QI X, GUO X.Diagnostic accuracy of APRI, AAR, FIB-4, FI, King, Lok, Forns, and Fibro Index scores in predicting the presence of esophageal varices in liver cirrhosis[J].Medicine (Baltimore) , 2015, 94 (42) :e1795.

[12]STEFANESCU H, GRIGORESCU M, LUPSOR M, et al.A new and simple algorithm for the noninvasive assessment of esophageal varices in cirrhotic patients using serum fibrosis markers and transient elastography[J].J Gastrointestin Liver Dis, 2011, 20 (1) :57-64.

[13]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) :630-638.

[14]MORISHITA N, HIRAMATSU N, OZELIVER T, et al.Liver stiffness measurement by acoustic radiation force impulse is useful in predicting the presence of esophageal varices or high-risk esophageal varices among patients with HCV-related cirrhosis[J].J Gastroenterol, 2014, 49 (7) :1175-1182.

施引文献

资源附件(0)

访问统计