肝硬度值和血小板计数/脾脏厚径比率对肝硬化食管胃底静脉曲张程度的预测价值

封爽; 冯慧芬; 徐晶; 余功超; 郑珊

doi:10.3969/j.issn.1001-5256.2021.12.018

肝硬度值和血小板计数/脾脏厚径比率对肝硬化食管胃底静脉曲张程度的预测价值

DOI: 10.3969/j.issn.1001-5256.2021.12.018

郑州大学第五附属医院消化内科，郑州 450052

基金项目:

中国肝炎防治基金会王宝恩肝纤维化研究基金 (2020006)

详细信息

通信作者:
冯慧芬，huifen.Feng@163.com

中图分类号: R575.2
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出版历程
- 收稿日期: 2021-05-29
- 录用日期: 2021-07-07
- 出版日期: 2021-12-20

Value of FibroScan and platelet count-to-spleen thickness ratio in predicting the degree of esophageal and gastric varices in liver cirrhosis

Department of Gastroenterology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

Research funding:

Wang Baoen Liver Fibrosis Research Foundation of China Hepatitis Prevention Foundation (2020006)

摘要

摘要: 目的探讨瞬时弹性成像技术(FibroScan)和血小板计数与脾脏厚径比率(PC/ST)对肝硬化食管胃底静脉曲张(EGV)程度的预测价值。方法选取2017年1月—2020年9月于郑州大学第五附属医院入院3 d内接受FibroScan、彩色多普勒超声、电子胃镜及血生化检查的肝硬化患者210例，以电子胃镜检查结果为“金标准”分为无、轻度、中度、重度EGV组。计量资料多组间比较采用One-Way ANOVA检验或Kruskal-Wallis H检验，并绘制肝硬度值(LSM)、PC/ST及LSM+PC/ST受试者工作特征曲线(ROC曲线)，通过DeLong法比较各指标ROC曲线的诊断性能。结果无、轻、中、重度EGV组的LSM(F=32.00，P＜0.01)和PC/ST值(H=49.58，P＜0.01)组间比较差异均有统计学意义。轻度EGV组LSM、PC/ST、LSM+PC/ST的ROC曲线下面积(AUC)分别为0.762、0.656、0.770，阳性预测值及阴性预测值分别为75.4%、75.0%，60.2%、75.8%，82.5%、65.4%；中度EGV组LSM、PC/ST、LSM+PC/ST的AUC分别为0.841、0.796、0.896，阳性预测值及阴性预测值分别为86.1%、79.7%，68.0%、80.5%，74.1%、90.2%；重度EGV组LSM、PC/ST、LSM+PC/ST的AUC分别为0.834、0.830、0.903，阳性预测值及阴性预测值分别为80.5%、82.5%，71.4%、83.6%，79.5%、85.0%。PC/ST与LSM+PC/ST预测轻、中、重度EGV的AUC组间比较，差异均有统计学意义(Z值分别为2.66、2.71、2.37，P值分别为0.007、0.007、0.018)。结论 LSM、PC/ST、LSM+PC/ST对肝硬化合并中重度EGV具有较好的预测价值。
- 肝硬化 /
- 食管和胃静脉曲张 /
- 弹性成像技术 /
- 诊断
Abstract: Objective To investigate the value of transient elastography (FibroScan) and platelet count-to-spleen thickness (PC/ST) ratio in predicting the degree of esophageal and gastric varices (EGV) in liver cirrhosis. Methods A total of 210 patients with liver cirrhosis who underwent FibroScan, color Doppler ultrasound, electronic gastroscopy, and blood biochemical examination within three days after admission to The Fifth Affiliated Hospital of Zhengzhou University from January 2017 to September 2020 were enrolled, and according to the "gold standard" of gastroscopy, the patients were divided into none, mild, moderate, and severe EGV groups. A one-way analysis of variance or the Kruskal-Wallis H test were used for comparison of continuous data between multiple groups. Receiver operating characteristic (ROC) curves were plotted for liver stiffness measurement (LSM), PC/ST ratio, and LSM+PC/ST, and the diagnostic performance of these ROC curves was compared using the Delong method. Results There were significant differences between the none, mild, moderate, and severe EGV groups in LSM (F=32.00, P < 0.01) and PC/ST ratio (H=49.58, P < 0.01). For the mild EGV group, LSM, PC/ST ratio, and LSM+PC/ST had an area under the ROC curve (AUC) of 0.762, 0.656, and 0.770, respectively, with a positive predictive value of 75.4%, 60.2%, and 82.5%, respectively, and a negative predictive value of 75.0%, 75.8%, and 65.4%, respectively. For the moderate EGV group, LSM, PC/ST ratio, and LSM+PC/ST had an AUC of 0.841, 0.796, and 0.896, respectively, with a positive predictive value of 86.1%, 68.0%, and 74.1%, respectively, and a negative predictive value of 79.7%, 80.5%, and 90.2%, respectively. For the severe EGV group, LSM, PC/ST ratio, and LSM+PC/ST had an AUC of 0.834, 0.830, and 0.903, respectively, with a positive predictive value of 80.5%, 71.4%, and 79.5%, respectively, and a negative predictive value of 82.5%, 83.6%, and 85.0%, respectively. PC/ST ratio and LSM+PC/ST had significantly different AUC in predicting mild, moderate, and severe EGV (Z=2.66, P=0.007; Z=2.71, P=0.007; Z=2.37, P=0.018). Conclusion LSM, PC/ST ratio, and LSM+PC/ST have a good predictive value for moderate-to-severe EGV in liver cirrhosis.
- Liver Cirrhosis /
- Esophageal and Gastric Varices /
- Elasticity Imaging Techniques /
- Diagnosis

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图 1 LSM、PC/ST、LSM+PC/ST预测不同程度食管静脉曲张的ROC曲线

注：a，轻度食管静脉曲张；b，中度食管静脉曲张；c，重度食管静脉曲张。

下载: 全尺寸图片幻灯片

表 1 LSM、PC/ST与食管静脉曲张程度的关系

分组	例数	LSM(kPa)	PC/ST
无静脉曲张组	60	16.60±5.03	2.74(1.82~5.01)
轻度静脉曲张组	61	21.07±4.64	2.06(1.45~2.93)
中度静脉曲张组	45	25.25±6.79¹⁾²⁾	1.44(0.91~2.00)¹⁾²⁾
重度静脉曲张组	44	28.53±9.71¹⁾²⁾	1.07(0.72~1.75)¹⁾²⁾
统计值		F=32.00	H=49.58
P值		＜0.01	＜0.01
注：与无食管静脉曲张组相比，1) P＜0.01;与轻度食管静脉曲张组相比，2) P＜0.01。

下载: 导出CSV

表 2 LSM、PC/ST、LSM+PC/ST对各组食管静脉曲张程度的预测价值

分组	AUC	截断值	敏感度(%)	特异度(%)	95% CI	阳性预测值(%)	阴性预测值(%)
轻度静脉曲张组
LSM	0.762	18.9	75.4	75.0	0.675~0.849	75.4	75.0
PC/ST	0.656	3.70	86.9	41.7	0.558~0.754	60.2	75.8
LSM+PC/ST	0.770¹⁾		54.1	88.3	0.687~0.854	82.5	65.4
中度静脉曲张组
LSM	0.841	22.5	68.9	91.7	0.762~0.922	86.1	79.7
PC/ST	0.796	1.95	75.6	73.3	0.711~0.880	68.0	80.5
LSM+PC/ST	0.896¹⁾		88.9	76.7	0.836~0.956	74.1	90.2
重度静脉曲张组
LSM	0.834	21.5	75.0	86.7	0.748~0.920	80.5	82.5
PC/ST	0.830	1.81	79.5	76.7	0.752~0.909	71.4	83.6
LSM+PC/ST	0.903¹⁾		79.5	85.0	0.848~0.959	79.5	85.0
注：与PC/ST相比，1) P＜0.05。

下载: 导出CSV

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