Objective To investigate the diagnostic value of endoscopic ultrasonography (EUS),Fibroscan,acoustic radiation force impulse (ARFI),and aspartate aminotransferase-to-platelet ratio (APRI)and their combination for early stage liver cirrhosis.Methods Three hundred and twenty-two hospitalized patients who had been diagnosed with chronic viral liver disease from March 2016 to April 2018 were included.According to the clinical diagnosis,patients were divided into chronic hepatitis and the early stage liver cirrhosis group (Child-Pugh A grade).All patients were examined by Fibroscan to detect liver stiffness measurement (LSM),ARFI to detect liver virtual touch tissue quantification (VTQ) value,esophagogastroduodenoscopy and EUS to detect esophagogastric varices,laboratory and imaging examination.The index of EUS,Fibroscan,ARFI,and APRI was analyzed and the regression model was established by binary logistic regression,and the diagnostic efficacy of the above index and regression model for early stage of cirrhosis was evaluated by the area under a receiver operating characteristic curve (AUROCs).Results An early stage cirrhosis group had significantly higher detection rate with EUS (esophagogastric varices),Fibroscan (LSM),ARFI (VTQ) and APRI than chronic hepatitis group [76.7％ vs.10.7％,10.4 (7.8,17.3) vs.6.1 (5.2,8.4) kPa,1.71(1.48,2.07) m/s vs.1.25(1.14,1.43)m/s and 0.65 (0.38,1.15) vs.0.38(0.26,0.62),respectively].The corresponding chi-square test were 140.86,Z =-9.069,Z =-9.948 and Z =-5.764,respectively and the differences were statistically significant (P ＜ 0.01).The areas under the receiver operating characteristic curve and regression model were 0.830 (0.783 ～ 0.877),0.793 (0.744 ～ 0.841),0.821 (0.775 ～ 0.868),0.686 (0.628 ～ 0.744) and 0.947 (0.925 ～ 0.969) for the diagnosis of early stage cirrhosis,respectively.Among them,the regression model of three indices (EUS,LSM and VTQ) had the largest AUROCs (0.947) and the corresponding sensitivity and specificity were 0.878 and 0.867,respectively.Conclusion The combination of EUS,LSM and ARFI had a superior diagnostic value for early stage liver cirrhosis,and may improve the diagnosis rate and reduce the misdiagnosis rate.%目的 探讨内镜超声检查(EUS)、Fibroscan、声辐射力脉冲成像技术(ARFI)、天冬氨酸氨基转移酶和血小板比率指数及其联合对早期肝硬化的诊断价值. 方法 收集2016年3月至2018年4月住院确诊的慢性病毒性肝病患者322例,根据临床诊断分为慢性肝炎组和早期肝硬化组(Child-Pugh A级).所有患者行Fibroscan、ARFI、胃镜、EUS、实验室检查和影像学检查.用Fibroscan测量肝硬度值、ARFI测量肝脏声触诊组织定量、普通胃镜及EUS检查食管胃底静脉有无曲张.通过二元logistic回归对EUS、Fibroscan、ARFI、天冬氨酸氨基转移酶和血小板比率指数分析并建立回归模型,采用受试者工作特征曲线下面积评估上述指标及回归模型对早期肝硬化的诊断效能.结果 早期肝硬化组EUS静脉曲张检出率、肝硬度值、声触诊组织定量和天冬氨酸氨基转移酶和血小板比率指数显著高于慢性肝炎组,分别为76.7％比10.7％、10.4 (7.8,17.3) kPa比6.1(5.2,8.4) kPa、1.71 (1.48,2.07) m/s比1.25 (1.14,1.43) m/s和0.65 (0.38,1.15)比0.38 (0.26,0.62),相对应的检验统计量分别为x2=140.86、Z=-9.069、Z=-9.948和Z=-5.764,差异均有统计学意义(P值均＜0.01).EUS、肝硬度值、声触诊组织定量、天冬氨酸氨基转移酶和血小板比率指数和回归模型对早期肝硬化诊断的受试者工作特征曲线下面积分别为0.830 (0.783 ～ 0.877)、0.793 (0.744 ～ 0.841)、0.821 (0.775 ～ 0.868)、0.686 (0.628 ～0.744)和0.947 (0.925 ～ 0.969),其中以包含EUS、肝硬度值及声触诊组织定量3项指标的回归模型的受试者工作特征曲线下面积最大,为0.947,相对应的敏感度和特异度分别为0.878和0.867. 结论 联合EUS、Fibroscan和ARFI3项检查对早期肝硬化具有更高的诊断价值,能够提高早期肝硬化的诊断率,减少漏诊率.
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