论著

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

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  • 上海交通大学医学院附属瑞金医院感染科,上海 200025

收稿日期: 2023-02-13

  网络出版日期: 2023-08-31

基金资助

国家自然科学基金(81570560)

Value of aMAP, APRI, FIB-4 and liver stiffness in predicting the degree of esophageal and gastric varices in patients with hepatitis B cirrhosis

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  • Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received date: 2023-02-13

  Online published: 2023-08-31

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。

本文引用格式

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 . DOI: 10.16150/j.1671-2870.2023.02.006

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.

参考文献

[1] 中华医学会肝病学分会,中华医学会消化病学分会, 中华医学会消化内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 临床肝胆病杂志, 2023, 39(3):527-538.
[1] Chinese Society of Hepatology,Chinese Society of Gastr-oenterology,and Chinese Society of Digestive Endoscopo-logy of Chinese Medical Association. Guidelines on the management of esophagogastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol, 2023, 39(3):527-538.
[2] GARCIA-TSAO G, ABRALDES J G, BERZIGOTTI A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice gui-dance by the American Association for the study of liver diseases[J]. Hepatology, 2017, 65(1):310-335.
[3] 中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版)[J]. 中华外科杂志, 2019, 57(12):885-892.
[3] Chinese Society of Spleen and Portal Hypertension Surgery, Chinese Society of Surgery, Chinese Medical Association. Expert consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension(2019 edition)[J]. Chin J Surg, 2019, 57(12):885-892.
[4] FAN R, PAPATHEODORIDIS G, SUN J, et al. aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis[J]. J Hepatol, 2020, 73(6):1368-1378.
[5] TESHALE E, LU M, RUPP L B, el al. APRI and FIB-4 are good predictors of the stage of liver fibrosis in chronic hepatitis B: the Chronic Hepatitis Cohort Study (CHeCS)[J]. J Viral Hepat, 2014, 21(12):917-920.
[6] 中华医学会肝病学分会,中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015更新版)[J]. 中华肝脏病杂志, 2015, 23(12):888-905.
[6] Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Infectious Diseases,Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B:a 2015 update[J]. Chin J Hepatol, 2015, 23(12):888-905.
[7] 中华医学会消化内镜学分会食管胃静脉曲张学组. 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年)[J]. 中华消化内镜杂志, 2010, 27(1):1-4.
[7] Committee of esophageal varicosity,Society of Digestive Endoscopy of Chinese Medical Association. Tentative guidelines for endoscopic diagnosis and treatment of varicosity and variceal bleeding in digestive tract (2009)[J]. Chin J Dig Endosc, 2010, 27(1):1-4.
[8] TESHALE E, LU M, RUPP L B, et al. APRI and FIB-4 are good predictors of the stage of liver fibrosis in chronic hepatitis B: the Chronic Hepatitis Cohort Study (CHeCS)[J]. J Viral Hepat, 2014, 21(12):917-920.
[9] ABOUGERGI M S, PELUSO H, MRAD C, et al. The Impact of Obesity on Mortality and Other Outcomes in Patients With Nonvariceal Upper Gastrointestinal Hemorrhage in the United States[J]. J Clin Gastroenterol, 2019, 53(2):114-119.
[10] GUI H L, HUANG Y, ZHAO G D, et al. External Validation of aMAP Hepatocellular Carcinoma Risk Score in Patients With Chronic Hepatitis B-Related Cirrhosis Receiving ETV or TDF Therapy[J]. Front Med (Lausanne), 2021, 8:677920.
[11] 王报, 牛俊奇. 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[J]. 临床肝胆病杂志, 2018, 34(1):84-88.
[11] WANG B, NIU J Q. 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[J]. J Clin Hepatol, 2018, 34(1):84-88.
[12] LERTNAWAPAN R, CHONPRASERTSUK S, SIRAMOLPIWAT S. Association between cumulative methotrexate dose, non-invasive scoring system and hepatic fibrosis detected by Fibroscan in rheumatoid arthritis patients receiving methotrexate[J]. Int J Rheum Dis, 2019, 22(2):214-221.
[13] OMAR H, SAID M, ELETREBY R, et al. Longitudinal assessment of hepatic fibrosis in responders to direct-ac-ting antivirals for recurrent hepatitis C after liver transplantation using noninvasive methods[J]. Clin Transplant, 2018, 32(8):e13334.
[14] 陈维, 徐德翠. Fibroscan检测肝脾硬度预测乙型肝炎病毒相关肝硬化食管胃底静脉曲张的价值[J]. 中西医结合肝病杂志, 2021, 31(7):645-647.
[14] CHEN W, XU D C. The Value of Fibroscan detection of liver and spleen stiffness in predicting esopha-gogastric varices in patients with hepatitis B virus-related cirrhosis[J]. Chin J Integr Tradit West Med Liver Dis, 2021, 31(7):645-647.
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