脾脏ARFI弹性值与APRI及AAR指数对肝硬化食管静脉曲张的预测价值

张大鹍; 陈敏; 皋月娟; 李猛; 王瑞芳

doi:10.3969/j.issn.1001-5256.2018.03.011

脾脏ARFI弹性值与APRI及AAR指数对肝硬化食管静脉曲张的预测价值

DOI: 10.3969/j.issn.1001-5256.2018.03.011

1. 中国中医科学院西苑医院超声科
2. 解放军第三○二医院超声科

基金项目:

首都临床特色应用研究专项课题(Z161100000516174)；

详细信息

中图分类号: R445.1;R575.2
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出版历程
- 收稿日期: 2017-10-18
- 出版日期: 2018-03-20

Clinical value of spleen acoustic radiation force impulse, aspartate aminotransferase-to-platelet ratio index, and aspartate aminotransferase/alanine aminotransferase ratio in predicting esophageal varices in patients with liver cirrhosis

Department of Ultrasound, Xiyuan Hospital, China Academy of Chinese Medical Sciences

Research funding:

摘要

摘要: 目的应用声辐射力脉冲成像（ARFI）技术和APRI（AST/PLT）及AAR（AST/ALT）指数对慢性肝炎肝硬化患者进行脾脏弹性检测和分析,探讨和对比上述三项无创技术对预测肝硬化食管静脉曲张（EV）的应用价值。方法选择2016年6月-2017年3月就诊于解放军第三○二医院的247例慢性肝炎肝硬化患者,应用ARFI技术检测脾脏实时超声弹性,并计算APRI及AAR指数,所有患者均于检测前后1周内行胃镜检查明确EV程度,以胃镜结果为金标准,应用受试者工作特征（ROC）曲线比较脾脏ARFI弹性、APRI和AAR诊断肝硬化EV的临床价值。2组间计量资料比较采用t检验。结果胃镜结果显示肝硬化伴EV患者169例（EV组）,无EV患者78例（无EV组）。EV组脾脏ARFI弹性、APRI和AAR分别为（3.64±0.53）m/s、0.8±0.91和1.54±0.67,无EV组分别为（2.97±0.65）m/s、0.52±0.80和1.29±0.55,2组间比较差异均有统计学意义（t值分别为-7.93、-2.90、-2.93,P值分别为<0.001、0.004、0.004）。脾脏ARFI弹性、AP...
- 弹性成像技术 /
- 肝硬化 /
- 食管疾病 /
- 静脉曲张
Abstract: Objective To investigate the spleen stiffness of patients with chronic hepatitis and liver cirrhosis by spleen acoustic radiation force impulse ( ARFI) , aspartate aminotransferase-to-platelet ratio index ( APRI) , and aspartate aminotransferase/alanine aminotransferase ratio ( AAR) , as well as the clinical value of these three noninvasive techniques in predicting esophageal varices ( EV) in patients with liver cirrhosis. Methods A total of 247 patients with chronic hepatitis and liver cirrhosis were enrolled, and ARFI was used to measure real-time spleen stiffness. APRI and AAR were calculated. Gastroscopy was performed within one week before and after measurement to clarify the degree of EV. With the results of gastroscopy as the gold standard, the receiver operating characteristic ( ROC) curve was used to compare the clinical value of spleen ARFI value, APRI, and AAR in the diagnosis of EV in patients with liver cirrhosis. The t-test was used for comparison of continuous data between two groups. Results There were significant differences between the EV group ( n = 169) and the non-EV group ( n = 78) in spleen ARFI stiffness ( 3. 64 ± 0. 53 m/s vs 2. 97 ± 0. 65 m/s, t =-7. 93, P < 0. 001) , APRI ( 0. 87 ±0. 91 vs 0. 52 ± 0. 80, t =-2. 90, P = 0. 004) , and AAR ( 1. 54 ± 0. 67 vs 1. 29 ± 0. 55, t =-2. 93, P = 0. 004) . Spleen ARFI, APRI, and AAR had an area under the ROC curve of 0. 80, 0. 72, and 0. 63, respectively, in predicting EV in patients with liver cirrhosis; there was a significant difference between spleen ARFI stiffness and AAR ( P = 0. 005) , while there was no significant difference between spleen ARFI stiffness and APRI ( P = 0. 10) . Conclusion ARFI is a real-time ultrasound elastography technique, and compared with APRI and AAR, spleen stiffness measured by ARFI can predict EV in patients with chronic hepatitis and liver cirrhosis more accurately and noninvasively and thus holds promise for clinical application.
- elasticity imaging techniques /
- liver cirrhosis /
- esophageal diseases /
- varicose veins

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参考文献(17)

[1]GARCIA-TSAO G.Current management of the complications of cirrhosis and portal hypertension:variceal hemorrhage, ascites, and spontaneous bacterial peritonitis[J].Gastroenterology, 2001, 120 (3) :726-748.

[2]YAN J.Analysis on effect of devascularization and endoscopic variceal ligation in treatment of patients with liver cirrhosis and esophageal variceal bleeding[J/CD].Chin J Liver Dis:Electronic Edition, 2017, 9 (1) :50-53. (in Chinese) 严瑾.断流术与内镜下套扎术对肝硬化食管静脉曲张出血患者的疗效分析[J/CD].中国肝脏病杂志 (电子版) , 2017, 9 (1) :50-53.

[3]Chinese Society of Infectious Diseases and Parasitology, Chinese Society of Hepatology, Chinese Medical Association.Prevention and treatment of viral hepatitis[J].Chin J Infect Dis, 2001, 19 (1) :56-62. (in Chinese) 中华医学会传染病与寄生虫病学分会、肝病学分会.病毒性肝炎防治方案[J].中华传染病杂志, 2001, 19 (1) :56-62.

[4] Chinese Society of Gastroenterology, Chinese Society of Hepatology, Chinese Society of Digestive Endoscopy.Consensus for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension (2008, Hangzhou) [J].Chin J Dig, 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.

[5]DENG H, QI XS, ZHU Q, et al.Alternative methods for diagnosis of esophageal varices in patients with liver cirrhosis[J].J Clin Hepotal, 2016, 32 (8) :1468-1473. (in Chinese) 邓晗, 祁兴顺, 朱强, 等.肝硬化食管静脉曲张的替代诊断方法[J].临床肝胆病杂志, 2016, 32 (8) :1468-1473.

[6]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.

[7]IWATA Y, ENOMOTO H, SAKAI Y, et al.Elevation of the AST to ALT ratio in association with the severity of esophageal varices in patients with HCV-related compensated liver cirrhosis[J].Hepatogastroenterology, 2013, 60 (121) :149-152.

[8]SALZL P, REIBERGER T, FERLITSCH M, et al.Evaluation of portal hypertension and varices by acoustic radiation force impulse imaging of the liver compared to transient elastography and AST to platelet ratio index[J].Ultraschall Med, 2014, 35 (6) :528-533.

[9]FENG J, PAN CW, HUANG CJ.The diagnostic value of APRI and AAR for the esophageal varices in patient with cirrhosis[J].Mod Digest Interv, 2013, 18 (3) :129-131. (in Chinese) 冯洁, 潘存伟, 黄成军.APRI、AAR对肝硬化食管静脉曲张的诊断价值[J].现代消化及介入诊疗, 2013, 18 (3) :129-131.

[10]DENG H, QI X, PENG Y, et al.Diagnostic accuracy of APRI, AAR, FIB-4, FI, and King scores for diagnosis of esophageal varices in liver cirrhosis:a retrospective study[J].Med Sci Monit, 2015, 21:3961-3977.

[11]WANG L, FENG Y, MA X, et al.Diagnostic efficacy of noninvasive liver fibrosis indexes in predicting portal hypertension in patients with cirrhosis[J].PLo S One, 2017, 12 (8) :e0182969.

[12]PARK J, KWON H, CHO J, et al.Is the spleen stiffness value acquired using acoustic radiation force impulse (ARFI) technology predictive of the presence of esophageal varices in patients with cirrhosis of various etiologies?[J].Med Ultrason, 2016, 18 (1) :11-17.

[13]HONG W, HAN RH, LYU ZH, et al.Feasibility study of predicting esophageal varices in cirrhosis patients with spleen shear wave[J].J Clin Ultrasound in Med, 2013, 15 (12) :827-830. (in Chinese) 洪玮, 韩鄂辉, 吕志红, 等.脾脏剪切波速预测肝硬化患者食管静脉曲张的可行性研究[J].临床超声医学杂志, 2013, 15 (12) :827-830.

[14]BOTA S, SPOREA I, SIRLI R, et al.Spleen assessment by Acoustic Radiation Force Impulse Elastography (ARFI) for prediction of liver cirrhosis and portal hypertension[J].Med Ultrason, 2010, 12 (3) :213-217.

[15]TAKUMA Y, NOUSO K, MORIMOTO Y, et al.Measurement of spleen stiffness by acoustic radiation force impulse imaging identifies cirrhotic patients with esophageal varices[J].Gastroenterology, 2013, 144 (1) :92-101.

[16]YOON KT, LIM SM, PARK JY, et al.Liver stiffness measurement using acoustic radiation force impulse (ARFI) elastography and effect of necroinflammation[J].Dig Dis Sci, 2012, 57 (6) :1682-1691.

[17]CHOI M, KWON H, CHO J.Serial change of liver stiffness measured by acoustic radiation force impulse imaging in chronic liver disease:correlation with biochemical markers[J].J Med Ultrason, 2014, 41 (3) :311-317.

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