FibroScan联合APRI预测肝硬化合并食管胃底静脉曲张程度及出血风险的相关研究

发布时间：2018-09-08 20:13

【摘要】：目的:探讨瞬时弹性成像技术(FibroScan)联合天冬氨酸氨基转移酶和血小板比率指数(Aspartate aminotransferase-to-Platelet Ratio Index APRI)检测肝硬化患者合并食管胃底静脉曲张程度及破裂出血风险的相关性和诊断预测价值。方法:1.选取河南科技大学第三附属医院于2013.1.1-2015.10.1行胃镜检查的病毒性肝炎肝炎后肝硬化患者210例,病毒性肝炎肝炎后肝硬化的诊断全部符合2013年人民卫生出版社出版的第八版《内科学》教材肝硬化的诊断标准;根据胃镜检查报告将210例病毒性肝炎肝硬化患者分为无、轻、中、重度食管胃底静脉曲张组;食管胃底静脉曲张(Esophagogastric Varices EGV)诊断标准全部符合由中华医学会消化内镜分会EGV学组制定的《消化道静脉曲张及出血的内镜诊断和治疗规范试行方案(2009)》;同时将210例肝硬化患者根据2008年由中华医学会肝病学分会、消化病学分会、消化内镜分会制定《肝硬化门静脉高压食管胃底静脉曲张出血(Esophageal Varices Bleeding EVB)的防治指南》分为有食管胃底静脉出血组(简称有出血组)、无食管胃底静脉出血组(简称无出血组)。2.同时收集所有入组病人在行胃镜检查同一时期内(3天内)所检测的Fibro Scan弹性值、天冬氨酸氨基转移酶(Aspartate aminotransferase AST)和血小板(Platelet PLT)的值,再计算出APRI值。3.采用SPSS22.0统计软件,计量资料用均数±标准差((X|-)±S)描述,两组定量资料的比较使用t检验,多组定量资料的比较经正态性和方差齐性检验,方差齐采用单因素方差分析,方差不齐采用Kruskal—Wallis检验;相关性分析采用Spearman相关分析;以胃镜检查诊断结果为金标准绘制受试者工作特征曲线(Receiver Operating Characteristic Curve,简称ROC曲线),选取最佳阈值即灵敏度和特异度之和最大值所对应的值,根据ROC曲线下的面积(The Area Under The Receiver Operating Characteristic Curves AUC)评价其诊断结果的准确性。结果:1.无、轻、中、重度食管静脉曲张患者的平均肝硬度值(Liver Stiffness Measure LSM,即FibroScan弹性值)依次是(17.94±3.72)kPa、(21.69±6.17)kPa、(26.58±6.69)kPa、(30.63±7.94)kPa;APRI平均值依次是(1.40±0.5)、(1.81±0.58)、(2.5±0.62)、(3.53±1.0),四组间比较差异有统计学意义(P0.05);轻度及以上食管胃底静脉曲张患者的LSM、APRI、LSM+APRI的ROC曲线下面积分别是0.856、0.900、0.906,灵敏度分别是0.632、0.847、0.889;中度及以上食管胃底静脉曲张患者的LSM、APRI、LSM+APRI的ROC曲线下面积分别是0.857、0.924、0.923,灵敏度分别是0.692、0.744、0.769;重度食管胃底静脉曲张患者的LSM、APRI、LSM+APRI的ROC曲线下面积分别是0.801、0.903、0.901,灵敏度分别是0.833、0.867、0.783。2.无、有出血组患者的LSM平均值分别是(22.87±6.95)kPa、(28.49±9.46)kPa,APRI平均值分别是(2.13±1.01)、(2.99±1.11),二组间比较差异有统计学意义(P0.05);有出血组肝硬化患者的LSM、APRI、LSM+APRI的AUC分别是0.669、0.727、0.722。3.LSM及APRI与胃镜分期具有较好的正相关性,相关系数(rs)依次为0.637,0.754(P0.01)。结论:1.FibroScan联合APRI对病毒性肝炎肝炎后肝硬化患者合并食管胃底静脉曲张的程度存在有效的诊断和预测价值。2.FibroScan联合APRI对病毒性肝炎肝炎后肝硬化患者合并食管胃底静脉曲张破裂出血的风险存在有效的诊断和预测价值。
[Abstract]:Objective: To investigate the correlation and diagnostic value of transient elastography (FibroScan) combined with aspartate aminotransferase-to-platelet Ratio Index (APRI) in detecting the severity of esophagogastric varices and the risk of rupture and bleeding in cirrhotic patients. 210 patients with viral hepatitis and posthepatitic cirrhosis underwent gastroscopy in the Third Affiliated Hospital of Technical University from January 13 to October 2015. The diagnosis of viral hepatitis and posthepatitic cirrhosis conformed to the diagnostic criteria of liver cirrhosis published in the eighth edition of "Internal Medicine" textbook published by the People's Health Publishing House in 2013. Patients with inflammatory liver cirrhosis were divided into no, mild, moderate and severe esophagogastric varices group, and the diagnostic criteria of esophagogastric varices (EGV) were all in accordance with the trial protocol for endoscopic diagnosis and treatment of gastrointestinal varices and bleeding (2009) formulated by the EGV group of the Chinese Medical Association. Patients with liver cirrhosis were divided into two groups according to the "Guidelines for the Prevention and Treatment of Esophageal Varices Bleeding EVB" formulated by the Society of Hepatology, the Society of Digestive Diseases and the Branch of Digestive Endoscopy of the Chinese Medical Association in 2008. Meanwhile, the values of Fibro Scan elasticity, Aspartate aminotransferase AST and platelet PLT were collected from all patients during the same period (3 days) of gastroscopy, and then the APRI values were calculated. 3. SPSS22.0 statistical software was used to calculate the mean (+) standard deviation of measurement data. (X | -) + S) descriptions, the comparison of two groups of quantitative data using t test, the comparison of multiple groups of quantitative data by normal and variance homogeneity test, variance homogeneity using one-way ANOVA, variance heterogeneity using Kruskal-Wallis test; correlation analysis using Spearman correlation analysis; gastroscopy diagnosis results as the gold standard to draw the work of the subjects. Receiver Operating Characteristic Curve (ROC Curve) was used to evaluate the diagnostic accuracy according to the area under the ROC curve (The Area Under The Receiver Operating Characteristic Curves AUC). Liver stiffness measurement LSM (FibroScan elasticity) was 17.94 (+ 3.72) kPa, 21.69 (+ 6.17) kPa, 26.58 (+ 6.69) kPa, 30.63 (+ 7.94) kPa, and APRI was (1.40 (+ 0.5)), (1.81 (+ 0.58)), (2.5 (+ 0.62)), (3.53 (+ 1.0)) with significant difference among the four groups (P 0.05). The ROC curves of LSM, APRI, LSM + APRI were 0.856, 0.900, 0.906, and the sensitivity was 0.632, 0.847, 0.889, respectively. The ROC curves of LSM, APRI, LSM + APRI were 0.857, 0.924, 0.923, 0.692, 0.744, 0.769 for moderate and above esophagogastric varices, respectively. The ROC curves of LSM, APRI and LSM+APRI were 0.801, 0.903 and 0.901, respectively, and the sensitivity was 0.833, 0.867 and 0.783.2. None. The mean LSM of patients with bleeding was (22.87 +6.95) kPa, (28.49 +9.46) kPa, and the mean APRI was (2.13 +1.01) and (2.99 +1.11), respectively. LSM, APRI, and LSM + APRI were 0.669, 0.727, 0.722.3. LSM and APRI were positively correlated with gastroscopic staging, and the correlation coefficients (rs) were 0.637, 0.754 (P 0.01). Conclusion: 1. FibroScan combined with APRI in patients with viral hepatitis cirrhosis complicated with esophageal and gastric varices. FibroScan combined with APRI has an effective diagnostic and predictive value for the risk of esophagogastric variceal bleeding in patients with post-viral hepatitis cirrhosis.
【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2

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