不同无创诊断模型对代偿期乙型肝炎肝硬化显著门静脉高压食管胃静脉曲张的诊断价值

刘诚; 曾嘉旖; 方梦冰; 陈智恒; 桂蓓; 赵凤鸣; 袁靖凯; 张朝臻; 施梅姐; 谢玉宝; 池晓玲; 萧焕明

doi:10.12449/JCH250211

不同无创诊断模型对代偿期乙型肝炎肝硬化显著门静脉高压食管胃静脉曲张的诊断价值

DOI: 10.12449/JCH250211

1.
广州中医药大学第二临床医学院，广州 510006
2.
广东省中医院，广州中医药大学第二附属医院肝病科，广州 510006

基金项目:

国家“十三五”重大传染病专项课题 (2018ZX10725506-003);

国家“十三五”重大传染病专项课题 (2018ZX10725505-004);

广东省中医药防治难治性慢病重点实验室项目 (the Second Hospital of Chinese Medicine［2023］200);

广东省自然科学基金 (2022A1515220188);

广东省自然科学基金 (2023A1515011092);

广东省自然科学基金 (2022A1515110825);

广东省院内专项 (YN10101903);

广东省院内专项 (YN2016XP03);

广东省院内专项 (YN2022DB04);

广东省院内专项 (YN2023MB04);

池晓玲国家中医药管理局名老中医药专家传承工作室项目 (Guozhong Pharmaceutical Human Education Letter ［2022］ No.75);

第五批全国中医临床优秀人才研修项目 (Guozhong Pharmaceutical Human Education Letter ［2022］ No.1)

伦理学声明：本研究方案于2024年2月20日经由广东省中医院伦理委员会批准同意，批号：YF2024-011-01。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：刘诚负责资料收集与分析，撰写论文；方梦冰、曾嘉旖、陈智恒、桂蓓、赵凤鸣、袁靖凯参与数据收集，修改论文；张朝臻、施梅姐、谢玉宝、池晓玲、萧焕明负责课题设计，指导撰写论文并最后定稿。

详细信息

通信作者:
萧焕明， xiaohuangming@163.com （ORCID： 0000-0002-8739-0720）

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出版历程
- 收稿日期: 2024-06-29
- 录用日期: 2024-07-22
- 出版日期: 2025-02-25

Value of different noninvasive diagnostic models in the diagnosis of esophageal and gastric varices with significant portal hypertension in compensated hepatitis B cirrhosis

1.
The Second Clinical Medical College of Guangzhou University of Chinese Medicine，Guangzhou 510006，China
2.
The Liver Department，Guangdong Provincial Hospital of Traditional Chinese Medicine，The Second Affiliated Hospital of Guangzhou University of Chinese Medicine，Guangzhou 510006，China

Research funding:

The Thirteenth Five-Year Plan for Major and Special Programs of the National Science and Technologyof China (2018ZX10725506-003);

The Thirteenth Five-Year Plan for Major and Special Programs of the National Science and Technologyof China (2018ZX10725505-004);

Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases (the Second Hospital of Chinese Medicine［2023］200);

Guangdong Provincial Natural Science Foundation (2022A1515220188);

Guangdong Provincial Natural Science Foundation (2023A1515011092);

Guangdong Provincial Natural Science Foundation (2022A1515110825);

The Clinical Research Projects of Guangdong Provincial Hospital of Chinese Medicine (YN10101903);

The Clinical Research Projects of Guangdong Provincial Hospital of Chinese Medicine (YN2016XP03);

The Clinical Research Projects of Guangdong Provincial Hospital of Chinese Medicine (YN2022DB04);

The Clinical Research Projects of Guangdong Provincial Hospital of Chinese Medicine (YN2023MB04);

Chi Xiaoling of Project of Inheritance Workshop of Famous Old Chinese Medicine Experts of State Administration of Traditional Chinese Medicine (Guozhong Pharmaceutical Human Education Letter ［2022］ No.75);

The Fifth Batch of National Research and Training Programs for Clinical Talents of Traditional Chinese Medicine (Guozhong Pharmaceutical Human Education Letter ［2022］ No.1)

More Information

Corresponding author: XIAO Huanming， xiaohuanming@163.com （ORCID： 0000-0002-8739-0720）

摘要

摘要: 目的代偿期乙型肝炎肝硬化显著门静脉高压患者发生食管胃静脉曲张（GOV）风险较大，通过评价不同无创诊断模型对GOV的诊断价值，为早期诊断GOV提供依据。方法选取2017年11月—2023年11月广东省中医院就诊的代偿期乙型肝炎肝硬化显著门静脉高压患者108例，根据胃镜下是否伴发GOV将患者分为GOV组和非GOV组（NGOV组）。收集患者的年龄、性别、影像学、实验室指标等结果。计数资料组间比较采用χ²检验；正态分布的计量资料两组间比较采用成组t检验；非正态分布的数据两组间比较采用Mann-Whitney U检验。采用受试者操作特征曲线（ROC曲线）评估FIB-4、LOK指数、LPRI、APRI、AAR等5种评分模型的诊断价值；利用二元Logistic回归构建联合模型，将联合模型与5种评分模型单独应用时的ROC曲线下面积（AUC）比较；采用Delong检验对各无创诊断模型的AUC值进行两两比较。结果 GOV组55例，NGOV组53例。GOV组的年龄高于NGOV组［（52.64±1.44）岁 vs（47.96±1.68）岁］，ALT［42.00（24.00～117.00） U/L vs82.00（46.00～271.00） U/L］、AST［44.00（32.00～96.00） U/L vs62.00（42.50～154.50） U/L］、PLT［100.00（69.00～120.00）×10⁹/L vs119.00（108.50～140.50）×10⁹/L］低于NGOV组，差异均有统计学意义（统计值分别为3.230、-3.065、-2.351、-3.667，P值均<0.05）。ROC曲线分析显示，FIB-4、LOK指数、LPRI、AAR单独诊断GOV的AUC分别为0.667、0.681、0.730、0.639（P值均<0.05），GOV阳性诊断率分别为69.97%、65.28%、67.33%、58.86%，AUC值比较差异均无统计学意义（P值均>0.05），APRI单独应用无诊断价值（P>0.05）。利用二元Logistic回归构建联合模型LAF，AUC为0.805，GOV阳性诊断率为75.80%，明显高于FIB-4、LOK指数、LPRI、AAR单独应用时的AUC值（Z值分别为-2.773、-2.479、-2.206、-2.672，P值均<0.05）。结论 FIB-4、LOK指数、LPRI、AAR对代偿期乙型肝炎肝硬化显著门静脉高压患者发生GOV诊断价值相似，APRI单独应用无诊断价值，联合模型LAF的诊断效能最佳，对临床推广和应用具有一定参考价值。
- 肝硬化 /
- 乙型肝炎 /
- 高血压，门静脉 /
- 食管和胃静脉曲张
Abstract: Objective To investigate the value of different noninvasive diagnostic models in the diagnosis of esophageal and gastric varices since there is a high risk of esophageal and gastric varices in patients with compensated hepatitis B cirrhosis and significant portal hypertension， and to provide a basis for the early diagnosis of esophageal and gastric varices. Methods A total of 108 patients with significant portal hypertension due to compensated hepatitis B cirrhosis who attended Guangdong Provincial Hospital of Traditional Chinese Medicine from November 2017 to November 2023 were enrolled， and according to the presence or absence of esophageal and gastric varices under gastroscopy， they were divided into esophageal and gastric varices group （GOV group） and non-esophageal and gastric varices group （NGOV group）. Related data were collected， including age， sex， imaging findings， and laboratory markers. The chi-square test was used for comparison of categorical data between groups； the least significant difference 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 receiver operating characteristic （ROC） curve was plotted to evaluate the diagnostic value of five scoring models， i.e.， fibrosis-4 （FIB-4）， LOK index， LPRI， aspartate aminotransferase-to-platelet ratio index （APRI）， and aspartate aminotransferase/alanine aminotransferase ratio （AAR）. The binary logistic regression method was used to establish a combined model， and the area under the ROC curve （AUC） was compared between the combined model and each scoring model used alone. The Delong test was used to compare the AUC value between any two noninvasive diagnostic models. Results There were 55 patients in the GOV group and 53 patients in the NGOV group. Compared with the NGOV group， the GOV group had a significantly higher age （52.64±1.44 years vs 47.96±1.68 years， t=0.453， P<0.05） and significantly lower levels of alanine aminotransferase ［42.00 （24.00 — 17.00） U/L vs 82.00 （46.00 — 271.00） U/L， Z=-3.065， P<0.05］， aspartate aminotransferase ［44.00 （32.00 — 96.00） U/L vs 62.00 （42.50 — 154.50） U/L，Z=-2.351， P<0.05］， and platelet count ［100.00 （69.00 — 120.00）×10⁹/L vs 119.00 （108.50 — 140.50）×10⁹/L， Z=-3.667， P<0.05］. The ROC curve analysis showed that FIB-4， LOK index， LPRI， and AAR used alone had an accuracy of 0.667， 0.681， 0.730， and 0.639， respectively， in the diagnosis of esophageal and gastric varices （all P<0.05）， and the positive diagnostic rates of GOV were 69.97%， 65.28%， 67.33%， and 58.86%， respectively， with no significant differences in AUC values （all P>0.05）， while APRI used alone had no diagnostic value （P>0.05）. A combined model （LAF） was established based on the binary logistic regression analysis and had an AUC of 0.805 and a positive diagnostic rate of GOV of 75.80%， with a significantly higher AUC than FIB-4， LOK index， LPRI， and AAR used alone （Z=-2.773，-2.479，-2.206， and-2.672， all P<0.05）. Conclusion FIB-4， LOK index， LPRI， and AAR have a similar diagnostic value for esophageal and gastric varices in patients with compensated hepatitis B cirrhosis and significant portal hypertension， and APRI alone has no diagnostic value. The combined model LAF had the best diagnostic efficacy， which provides a certain reference for clinical promotion and application.
- Liver Cirrhosis /
- Hepatitis B /
- Hypertension， Portal /
- Esophageal and Gastric Varices

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图 1 不同无创诊断模型诊断GOV的ROC曲线分析

Figure 1. ROC curve analysis of different non-invasive diagnostic models for esophageal and gastric varices

下载: 全尺寸图片幻灯片

表 1 两组患者基线资料比较

Table 1. Comparison of baseline characteristics among the two groups of patients

指标	GOV组（n=55）	NGOV组（n=53）	统计值	P值
男/女（例）	48/7	39/14	χ²=3.230	0.072
年龄（岁）	52.64±1.44	47.96±1.68	t=0.453	0.037
LSM（kPa）	32.40（26.60～38.90）	29.90（26.70～35.80）	Z=-1.025	0.306
ALT（U/L）	42.00（24.00～117.00）	82.00（46.00～271.00）	Z=-3.065	0.002
AST（U/L）	44.00（32.00～96.00）	62.00（42.50～154.50）	Z=-2.351	0.019
TBil（mmol/L）	24.30（15.80～36.18）	22.90（15.70～41.25）	Z=-0.246	0.805
Alb（g/L）	39.36（34.00～43.50）	39.36（38.85～43.40）	Z=-0.998	0.318
ALP（U/L）	110.00（84.00～126.00）	115.60（86.00～115.60）	Z=-0.291	0.771
GGT（U/L）	88.00（43.00～120.27）	99.00（65.50～160.50）	Z=-1.692	0.091
INR	1.18（1.13～1.22）	1.18（1.14～1.22）	Z=-0.461	0.645
PLT（10⁹/L）	100.00（69.00～120.00）	119.00（108.50～140.50）	Z=-3.667	<0.001

下载: 导出CSV

表 2 各无创模型单独或联合应用对GOV诊断效能的比较

Table 2. Comparison of the diagnostic efficacy of non-invasive diagnostic models alone or in combination for esophageal and gastric varices

指标	临界值	AUC（95%CI）	P值	敏感度（%）	特异度（%）	阳性预测值（%）	阴性预测值（%）	P值^1）
FIB-4	3.425	0.667（0.564～0.770）	0.003	65.5	69.8	69.97	67.97	0.005
LOK	0.777	0.681（0.580～0.781）	0.001	70.9	60.4	65.28	61.90	0.014
LPRI	0.397	0.730（0.635～0.824）	<0.001	66.5	75.5	67.33	77.42	0.028
AAR	0.245	0.639（0.535～0.743）	0.013	83.5	39.6	58.86	72.66	0.007
APRI	0.546	0.466（0.355～0.576）	0.537	96.4	13.2	53.54	80.82	<0.001
LAF	-0.185	0.805（0.722～0.887）	<0.001	80.0	73.6	75.80	56.56
注：1）P值表示联合模型LAF与其他模型AUC比较结果。

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