aMAP、APRI、FIB-4及肝硬度评估乙型肝炎肝硬化患者食管胃静脉曲张程度的价值探讨

doi:10.16150/j.1671-2870.2023.02.006

摘要/Abstract

摘要：

目的：探讨aMAP(age-male-ALBI-platelet, aMAP)、天门冬氨酸氨基转移酶/血小板比率指数（aspartate aminotransferase-to-platelet ratio index，APRI）、基于4因子的肝纤维化指数(fibrosis index based on the 4 factors， FIB-4)及肝硬度值（liver stiffness measurement，LSM）评估乙型肝炎（乙肝）肝硬化患者食管胃静脉曲张(esophageal gastric varices，EGV)程度的价值。方法：选取2018年4月到2022年5月期间在上海交通大学医学院附属瑞金医院确诊并接受治疗的乙肝肝硬化患者114例，对其进行肝功能、血常规、LSM、胃镜等检查，根据计算公式计算aMAP、APRI、FIB-4。根据胃镜结果将患者分为无EGV组（39例）、轻度EGV组（30例）、中度EGV组（23例）及重度EGV组（22例），比较4组间的aMAP、APRI、FIB-4。采用受试者操作特征曲线(receiver operator characteristic curve, ROC曲线)分析aMAP、APRI、FIB-4及LSM评估乙肝肝硬化患者EGV程度的价值。结果：EGV患者（包括轻度、中度及重度EGV组）的aMAP、APRI、FIB-4、LSM均显著高于无EGV的患者，差异有统计学意义(P<0.05)。轻度、中度及重度EGV组间的aMAP、APRI、FIB-4差异均有统计学意义(P<0.05)；轻度EGV组与中度、重度EGV组间LSM差异有统计学意义(P<0.05)。aMAP评估EGV程度的ROC曲线下面积（the area under ROC curve, AUROC）为0.76，灵敏度为85.9%，特异度为65.7%；APRI、FIB-4和LSM评估EGV程度的AUROC分别为0.86、0.85、0.79，灵敏度分别为81.30%、82.80%、88.40%，特异度分别为82.90%、77.10%、66.80%。aMAP、APRI、FIB-4和LSM对肝硬化患者是否合并EGV有较好诊断价值(P<0.05)。aMAP、APRI、FIB-4对乙肝肝硬化患者的EGV程度有一定诊断价值(P<0.05)，但特异度较低。结论：aMAP、APRI、FIB-4及LSM诊断乙肝肝硬化患者伴EGV的价值较高，而aMAP、APRI及FIB-4对其EGV程度有一定评估价值，可作为不适合做胃镜患者评估EGV的补充参考，为EGV的预防及治疗提供依据。

关键词: 食管胃底静脉曲张, aMAP, 天门冬氨酸氨基转移酶/血小板比率指数, 基于4因子的肝纤维化指数, 基于4因子的肝纤维化指数

Abstract:

Objective: To explore the predictive value of age-male-ALBI-platelets (aMAP), aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis index based on the 4 factors (FIB-4) and liver stiffness measurement (LSM) on the degree of esophageal and gastric varices (EGV) in patients with hepatitis B cirrhosis. Methods: One hundred and fourteen patients with hepatitis B cirrhosis in Shanghai Ruijin Hospital from April 2018 to May 2022 were enrolled. Examinations including liver function, blood routine, LSM and gastroscopy were performed. aMAP, APRI, and FIB-4 were calculated using the calculation formulas of each model. Based on the results of gastroscopy, the patients were divided into four groups: non-EGV group (39 cases), mild EGV group (30 cases), moderate EGV group (23 cases) and severe EGV group (22 cases), and aMAP, APRI, FIB-4 between groups were compared. The receiver operator characteristic curve (ROC curve) was used to analyze the predictive value of aMAP, APRI, FIB-4 and LSM on the degree of EGV in patients with hepatitis B cirrhosis. Results: The aMAP, APRI, FIB-4 and LSM of patients with EGV groups (including mild, moderate and severe EGV groups) were significantly higher than those of the non-EGV group (P<0.05). The area under ROC (AUROC) of aMAP for evaluating the degree of EGV was 0.76, with sensitivity of 85.9% and specificity of 65.7%. The AUROC of APRI, FIB-4 and LSM for evaluating the degree of EGV were 0.86, 0.85 and 0.79 respectively, and the sensitivities were 81.30%, 82.80% and 88.40% respectively, and the specificities were 82.90%, 77.10% and 66.80% respectively. aMAP, APRI, FIB-4 and LSM have a good predictive value for EGV in patients with liver cirrhosis (P<0.05). Compared with the aMAP, APRI, FIB-4 and LSM in patients with mild, EGV, the aMAP, APRI and FIB-4 of patients with moderate and severe of EGV were significantly different (P<0.05). There was a significant difference in LSM between mild EGV group and moderate-severe group (P<0.05). aMAP, APRI and FIB-4 have certain predictive values for the degree of EGV in hepatitis B cirrhosis patients (P<0.05), with decreased sensitivi-ty and specificity. Conclusions： aMAP, APRI, FIB-4 and LSM are of high predictive value for the presence of EGV in patients with hepatitis B cirrhosis. aMAP, APRI and FIB-4 have certain predictive values for the degree of EGV and can be used as a supplementary method for the evaluation of EGV by invasive gastroscopy, and can provide the basis for the prevention and treatment of EGV.

Key words: Esophageal and gastric varices, Age-male-albi-platelets, Aspartate aminotransferase-to-platelet ratio index, Fibrosis index based on the 4 factors, Liver stiffness measurement

中图分类号:

R571.3

安宝燕, 郭清, 冯明洋, 徐玉敏, 蔡伟, 谢青, 王晖. aMAP、APRI、FIB-4及肝硬度评估乙型肝炎肝硬化患者食管胃静脉曲张程度的价值探讨[J]. 诊断学理论与实践, 2023, 22(02): 141-146.

AN Baoyan, GUO Qing, FENG Mingyang, XU Yumin, CAI Wei, XIE Qing, WANG Hui. Value of aMAP, APRI, FIB-4 and liver stiffness in predicting the degree of esophageal and gastric varices in patients with hepatitis B cirrhosis[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(02): 141-146.

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Indice	non-EGV	EGV	t	P
ALT（IU/L）	25.57±7.18	27.93±8.71	1.52	0.15
AST（IU/L）	30.79±6.32	38.17±11.20	1.38	0.18
AKP（IU/L）	97.25±37.00	101.89±44.39	1.73	0.10
γ-GT（IU/L）	31.86±20.08	34.82±21.85	2.11	0.08
PLT（×10⁹L）	135±67	56±46	5.89	0.01
aMAP	53.83±6.79	62.52±7.36	4.91	<0.01
APRI	0.57±0.37	1.77±0.69	6.04	<0.01
FIB-4	2.21±1.07	5.66±3.09	5.40	<0.01
LSM(kPa)	10.44±3.72	17.62±7.43	3.86	<0.01

Indice	Mild EGV group	Moderate EGV group	Severe EGV group
aMAP	55.91±4.74	63.64±8.16	68.50±5.34
LSM	13.38±5.21	19.04±7.56	20.01±7.46
APRI	1.15±0.62	1.82±0.87	2.62±0.60
FIB-4	4.47±2.86	5.86±4.32	6.74±1.93

Indice	AUROC	95%CI	Sensitivity（%）	Specificigy（%）	P
aMAP	0.76	0.66-0.87	85.90	65.70	<0.01
APRI	0.86	0.77-0.94	81.30	82.90	<0.01
FIB	0.85	0.77-0.94	82.80	77.10	<0.01
LSM(KPa)	0.79	0.70-0.88	88.40	66.80	<0.01

Indice	AUROC	95%CI	Sensitivity（%）	Specificigy（%）	P
aMAP	0.64	0.52-0.74	90.20	48.30	0.02
APRI	0.72	0.62-0.82	82.90	58.60	<0.01
FIB-4	0.74	0.64-0.84	78.00	62.10	<0.01
LSM(kPa)	0.56	0.44-0.67	97.60	27.00	0.31