肝脾硬度联合血清腺苷脱氨酶对乙型肝炎肝硬化重度食管静脉曲张的预测价值分析

谢青; 李曾; 唐臻; 李金强; 刘凤娥

doi:10.3969/j.issn.1001-5256.2021.06.020

肝脾硬度联合血清腺苷脱氨酶对乙型肝炎肝硬化重度食管静脉曲张的预测价值分析

DOI: 10.3969/j.issn.1001-5256.2021.06.020

长沙市第一医院感染科，长沙 410000

基金项目:

湖南省卫生健康委科研计划项目 (20200163)

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：谢青负责课题设计，资料分析，撰写论文；李曾、唐臻参与收集数据，修改论文；李金强负责拟定写作思路、指导撰写文章及修改论文；刘凤娥参与修改论文及最后定稿。

详细信息

作者简介:
谢青(1988—)，女，主治医师，主要从事乙型肝炎肝硬化及肝癌早期筛查方面的研究

通信作者:
李金强，844456240@qq.com

刘凤娥，1633836831@qq.com

中图分类号: R512.62;R575.2
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出版历程
- 收稿日期: 2020-10-31
- 录用日期: 2020-12-02
- 出版日期: 2021-06-20

Value of liver/spleen stiffness combined with serum adenosine deaminase in predicting severe esophageal varices in patients with hepatitis B cirrhosis

Department of Infectious Diseases, Changsha First Hospital, Changsha 410000, China

摘要

摘要: 目的评价FibroTouch(FT)瞬时弹性成像技术测量肝脾硬度及其联合血清腺苷脱氨酶(ADA)对乙型肝炎肝硬化患者重度食管静脉曲张(EV)的预判价值。方法选取2017年12月—2020年6月在长沙市第一医院感染科就诊的120例乙型肝炎肝硬化患者的临床资料，FT测量肝脏硬度值(LSM)和脾脏硬度值(SSM)，完善电子胃镜、血清ADA、Hb、PLT、Alb、ALT及AST检查，计算血清肝纤维化指标APRI、AAR及FIB-4。将研究对象根据胃镜下EV程度，分为重度EV组(n=58)和非重度(无或轻中度)EV组(n=62)。满足正态分布的计量资料2组间比较采用t检验，非正态性的计量资料2组间比较采用Mann-Whitney U检验，计数资料2组间比较采用χ²检验。采用Spearman秩相关检验分析LSM、SSM、ADA与重度EV的关系。采用受试者工作特征曲线(ROC曲线)分析LSM、SSM、ADA诊断重度EV的效能，计算敏感度及特异度，行二分类变量logistic回归，计算联合指标的ROC曲线下面积(AUC)，AUC比较应用Z检验。结果 LSM、SSM与ADA在2组间比较差异均有统计学意义(P值均＜0.05)。LSM、SSM、ADA与重度EV之间均存在显著正相关，相关系数分别为0.686、0.743和0.723(P值均＜0.05)。LSM、SSM、ADA预判重度EV的最佳阈值分别为22.35 kPa、45.25 kPa和34.50 U/L，AUC分别为0.746、0.802和0.791，灵敏度分别为82.8%、75.9%和58.6%，特异度分别为65.6%、77.4%和90.2%。LSM+ADA、SSM+ADA、LSM+SSM+ADA联合预判重度EV的AUC分别为0.826、0.853和0.907(P值均＜0.05)。结论肝脾硬度联合血清ADA对重度EV具有较好的预判价值，能够为临床上拒绝行胃镜检查患者预测重度EV提供初步诊断依据。
- 乙型肝炎 /
- 肝硬化 /
- 食管和胃静脉曲张
Abstract: Objective To investigate the value of liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) based on FibroTouch (FT) transient elastography combined with serum adenosine deaminase (ADA) in predicting severe esophageal varices (EV) in patients with hepatitis B cirrhosis. Methods Related clinical data were collected from 120 patients with hepatitis B cirrhosis who attended Department of Infectious Diseases, Changsha First Hospital, from December 2017 to June 2020. FT was used to measure LSM and SSM, and related examinations were performed, including electronic gastroscopy and serum levels of ADA, hemoglobin, albumin, alanine aminotransferase, and aspartate aminotransferase and platelet count. The serum liver fibrosis markers aspartate aminotransferase-to-platelet ratio index (APRI), aspartate aminotransferase/alanine aminotransferase ratio (AAR), and fibrosis-4 (FIB-4) were calculated. According to the severity of EV under gastroscopy, the subjects were divided into severe EV group with 58 patients and non-severe EV (without EV or with mild-to-moderate EV) group with 62 patients. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The Spearman rank correlation test was used to investigate the correlation of LSM, SSM, and ADA with severe EV. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of LSM, SSM, and ADA in the diagnosis of severe EV, and sensitivity and specificity were calculated. A multivariate binary logistic regression analysis was performed to calculate the area under the ROC curve (AUC) of the combined indicators, and the Z test was used for comparison of AUC. Results There were significant differences in LSM, SSM, and ADA between the two groups (all P < 0.05). LSM, SSM, and ADA were positively correlated with severe EV, with a correlation coefficient of 0.686, 0.743, and 0.723, respectively (all P < 0.05). The optimal cut-off value was 22.35 kPa for LSM, 45.25 kPa for SSM, and 34.50 U/L for ADA in predicting severe EV, with an AUC of 0.746, 0.802, and 0.791, respectively, a sensitivity of 82.8%, 75.9%, and 58.6%, respectively, and a specificity of 65.6%, 77.4%, and 90.2%, respectively. LSM+ADA, SSM+ADA, and LSM+SSM+ADA had an AUC of 0.826, 0.853, and 0.907, respectively, in predicting severe EV (all P < 0.05). Conclusion Liver/spleen stiffness combined with serum ADA has a good value in predicting severe EV, which can provide a preliminary diagnostic basis for severe EV in patients who refuse to undergo gastroscopy.
- Hepatitis B /
- Liver Cirrhosis /
- Esophageal and Gastric Varices

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图 1 LSM、SSM、ADA诊断重度EV的ROC曲线

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图 2 联合指标诊断重度EV的ROC曲线

下载: 全尺寸图片幻灯片

表 1 两组患者各指标比较

指标	重度EV组(n=58)	非重度EV组(n=62)	统计值	P值
男/女(例)	48/10	54/8	χ²=0.44	0.506
年龄(岁)	52.41(47.05~57.77)	52.32(45.58~59.06)	Z=0.08	0.935
病程(年)	5.48(3.12~7.84)	5.24(2.64~7.84)	Z=0.52	0.602
LSM(kPa)	25.33(20.48~30.18)	22.28(19.10~25.46)	Z=4.11	＜0.001
SSM(kPa)	49.01(42.93~55.09)	43.38(39.81~46.94)	Z=6.27	＜0.001
PLT(×10⁹/L)	67.01(49.45~84.62)	70.55(56.65~84.45)	Z=1.22	0.224
Hb(g/L)	80.45(65.93~94.97)	83.42(73.7~93.14)	Z=1.33	0.191
Alb(g/L)	28.82(25.34~32.30)	28.68(25.72~31.64)	Z=0.24	0.814
ADA(U/L)	35.71(28.11~43.31)	28.02(20.73~35.31)	Z=6.59	＜0.001
APRI	0.39(0.19~0.51)	0.35(0.21~0.57)	Z=1.35	0.172
AAR	0.94(0.49~1.39)	0.85(0.61~1.10)	Z=1.31	0.193
FIB-4	0.81(0.05~1.58)	0.62(0.34~0.90)	Z=1.87	0.064

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表 2 LSM、SSM在观察者间的可重复性分析

指标	操作者A	操作者B	P值¹⁾	相关系数及P值
LSM(kPa)	20.81±1.82	21.32±1.97	0.305	0.75(P＜0.001)
SSM(kPa)	39.35±2.44	39.75±2.42	0.526	0.82(P＜0.001)
注：1)采用配对样本t检验。

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