肝硬化患者食管静脉曲张程度无创诊断的临床研究

摘要

Objective To investigate reliability of FibroScan (FS) in diagnosing size of oesophageal varices (OV) in patients with liver cirrhosis.Methods A total of 260 patients with liver cirrhosis were enrolled in the study.All patients underwent endoscopy to assess OV stage and FS to measure liver stiffness.Receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic reliability of FS.Results The FS values according to OV stage were 20.9 ± 10.3 kPa for patients without OV,32.2 ± 13.5 kPa for patients with mild OV,45.6 ± 18.3 kPa for patients with moderate OV,and 55.1 ± 15.6 kPa for patients with severe OV.Significant differences were found among the groups (P ＜ 0.001) as well as between any two groups (t =6.574,10.533,13.247,4.719,7.072 and 2.171,P ＜ 0.05 respectively).ROC curves of FS for the diagnoses of patiems with various OV stages showed the following:with vs.without OV,0.824 (95％ CI:77.5％ to 87.4％); ＜ moderate vs.＞ moderate OV,0.849 (95％ CI:79.6％ to 90.2％); and ＜ severe vs.severe OV,0.871 (95％ CI:81.1％ to 93.0％); the corresponding FS cut-offvalues were 22.8 kPa,30.6 kPa,and 34.6 kPa.Conclusion Liver stiffness measurement by FibroScan allows prediction of the oesophageal varices stage in patients with liver cirrhosis.%目的 探讨肝脏瞬时弹性扫描仪(FS)对于肝硬化患者食管静脉曲张程度的诊断能力.方法 纳入肝硬化患者260例,患者入院后均行FS、腹部超声以及电子胃镜检查;均抽血进行肝功能、肾功能、血常规、凝血功能、肝炎病毒标志物检测.瞬时弹性扫描仪为法国Echosens公司,型号FibroScan502,由2名有丰富经验的操作者(2年以上,＞1万例次操作)独立完成,按照仪器标准操作方法进行,于右腋前线和腋中线之间第7、8肋间,分别进行10次有效测量,最后取中位数为FS值(kPa),代表肝组织的弹性;检测值四分位间距/中位数(IQR/median)＜0.21认为检测结果可靠.电子胃镜检查由熟练的专科医生操作完成,OV内镜下分级标准参照2003年OV内镜下诊断和治疗规范试行方案标准:按OV的形态及出血危险程度分轻、中、重3级.本试验主要评估FS值和OV程度之间的关系、FS值判断OV的效能.应用SPSS 13.0统计软件对数据进行处理.多组间均数比较采用方差分析、两组间均数比较采用t检验.采用受试者工作特征曲线评价诊断能力. 结果 FS检测值:无食管静脉曲张患者(106例)平均值为(20.9±10.3) kPa、轻度食管静脉曲张患者(85例)平均值为(32.2±13.5)kPa、中度食管静脉曲张患者(45例)平均值为(45.6±18.3) kPa、重度食管静脉曲张患者(24例)平均值为(55.1±15.6) kPa.各组间比较,F=62.3,P＜0.01,差异有统计学意义.组间两两比较,t值分别为6.574,10.533,13.247,4.719,7.072,2.171,P值均＜0.05,差异均有统计学意义.FS值评估是否存在静脉曲张、中度静脉曲张和重度静脉曲张的ROC曲线下面积分别为0.824 (95％CI:77.5％～ 87.4％)、0.849 (95％CI:79.6％～ 90.2％)和0.871(95％CI:81.1％～ 93.0％),对应cut-off值分别是22.8kPa、30.6kPa和34.6kPa.结论 FS检测可以用来诊断肝硬化患者食管静脉曲张程度.