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脾脏ARFI弹性值与APRI及AAR指数对肝硬化食管静脉曲张的预测价值
Clinical value of spleen acoustic radiation force impulse, aspartate aminotransferase-to-platelet ratio index, and aspartate aminotransferase/alanine aminotransferase ratio in predicting esophageal varices in patients with liver cirrhosis
文章发布日期:2018年02月07日  来源:  作者:张大鹍,陈敏,皋月娟,等  点击次数:379次  下载次数:59次

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【摘要】:目的应用声辐射力脉冲成像(ARFI)技术和APRI(AST/PLT)及AAR(AST/ALT )指数对慢性肝炎肝硬化患者进行脾脏弹性检测和分析,探讨和对比上述三项无创技术对预测肝硬化食管静脉曲张(EV)的应用价值。方法选择2016年6月-2017年3月就诊于解放军第三○二医院的247例慢性肝炎肝硬化患者,应用ARFI技术检测脾脏实时超声弹性,并计算APRI及AAR指数,所有患者均于检测前后1周内行胃镜检查明确EV程度,以胃镜结果为金标准,应用受试者工作特征(ROC)曲线比较脾脏ARFI弹性、APRI和AAR诊断肝硬化EV的临床价值。2组间计量资料比较采用t检验。结果胃镜结果显示肝硬化伴EV患者169 例(EV组),无EV患者78 例(无EV组)。EV组脾脏ARFI弹性、APRI和AAR分别为(3.64±0.53)m/s、 0.8±0.91 和1.54±0.67,无EV组分别为(297±065)m/s、0.52±0.80 和1.29±0.55,2组间比较差异均有统计学意义(t值分别为-7.93、-2.90、-2.93,P值分别为<0.001、0004、0.004)。脾脏ARFI弹性、APRI和AAR预测肝硬化EV的ROC曲线下面积分别为0.80、0.72和0.63,脾脏ARFI弹性与AAR相比差异有统计学意义(P=0.005),脾脏ARFI弹性与APRI相比差异无统计学意义(P=0.10)。结论ARFI技术作为实时超声弹性成像技术,脾脏ARFI弹性较APRI和AAR能更准确地无创预测慢性肝炎肝硬化EV的存在,具有良好的临床应用前景。
【Abstract】:ObjectiveTo investigate the spleen stiffness of patients with chronic hepatitis and liver cirrhosis by spleen acoustic radiation force impulse (ARFI), aspartate aminotransferase-to-platelet ratio index (APRI), and aspartate aminotransferase/alanine aminotransferase ratio (AAR), as well as the clinical value of these three noninvasive techniques in predicting esophageal varices (EV) in patients with liver cirrhosis. MethodsA total of 247 patients with chronic hepatitis and liver cirrhosis were enrolled, and ARFI was used to measure real-time spleen stiffness. APRI and AAR were calculated. Gastroscopy was performed within one week before and after measurement to clarify the degree of EV. With the results of gastroscopy as the gold standard, the receiver operating characteristic (ROC) curve was used to compare the clinical value of spleen ARFI value, APRI, and AAR in the diagnosis of EV in patients with liver cirrhosis. The t-test was used for comparison of continuous data between two groups. ResultsThere were significant differences between the EV group (n=169) and the non-EV group (n=78) in spleen ARFI stiffness (3.64±0.53 m/s vs 2.97±0.65 m/s, t=-7.93, P<0.001), APRI (0.87±091 vs 0.52±0.80, t=-2.90, P=0.004), and AAR (1.54±0.67 vs 1.29±0.55, t=-2.93, P=0.004). Spleen ARFI, APRI, and AAR had an area under the ROC curve of 0.80, 0.72, and 0.63, respectively, in predicting EV in patients with liver cirrhosis; there was a significant difference between spleen ARFI stiffness and AAR (P=0.005), while there was no significant difference between spleen ARFI stiffness and APRI (P=0.10). ConclusionARFI is a real-time ultrasound elastography technique, and compared with APRI and AAR, spleen stiffness measured by ARFI can predict EV in patients with chronic hepatitis and liver cirrhosis more accurately and noninvasively and thus holds promise for clinical application.
【关键字】:弹性成像技术; 肝硬化; 食管疾病; 静脉曲张
【Key words】:elasticity imaging techniques; liver cirrhosis; esophageal diseases;varicose veins
【引证本文】:ZHANG DK, CHEN M, GAO YJ, et al. Clinical value of spleen acoustic radiation force impulse, aspartate aminotransferase-to-platelet ratio index, and aspartate aminotransferase/alanine aminotransferase ratio in predicting esophageal varices in patients with liver cirrhosis[J]. J Clin Hepatol, 2018, 34(3): 508-512. (in Chinese)
张大鹍, 陈敏, 皋月娟, 等. 脾脏ARFI弹性值与APRI及AAR指数对肝硬化食管静脉曲张的预测价值[J]. 临床肝胆病杂志, 2018, 34(3): 508-512.

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