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目的:评估瞬时弹性成像(FS)技术联合天冬氨酸转氨酶/血小板比值指数(APRI)、FIB-4指数预测肝硬化食管静脉曲张程度的临床价值。方法:回顾性分析2014年1月至2015年1月广州市第八人民医院收治的154例肝硬化Child-Pugh A级患者的临床资料,均行胃镜、FS测量肝脏硬度值(FS值)、肝功能及血常规等生化指标检测,应用受试者工作曲线评估FS值、APRI、FIB-4指数预测肝硬化患者食管静脉曲张程度的能力。结果:肝硬化患者中无食管静脉曲张,轻度、中度、重度食管静脉曲张者肝脏FS值分别为(17.28±7.67)、(21.64±7.67)、(31.54±3.68)、(40.40±6.46)k Pa。各组FS值、APRI、FIB-4比较,差异均有统计学意义(均P<0.05)。FS值对轻、中、重度食管静脉曲张预测曲线下面积分别为0.854、0.917、0.924,最佳诊断值分别为26.2、30.9、34.4 k Pa。三者联合诊断轻、中、重度食管静脉曲张的曲线下面积分别为0.921、0.919、0.918。结论:FS相对于APRI、FIB-4能更好地预测肝硬化患者食管静脉曲张程度,联合应用可部分提高诊断性能。
Objective: To evaluate the clinical value of transient elastography (FS) combined with aspartate aminotransferase / platelet ratio index (APRI) and FIB-4 index in predicting the degree of esophageal varices in cirrhosis. Methods: The clinical data of 154 Child-Pugh class A patients with liver cirrhosis admitted from the Eighth People’s Hospital of Guangzhou from January 2014 to January 2015 were retrospectively analyzed. Gastroscopy and FS were used to measure the liver hardness (FS) Liver function and blood biochemical markers such as biochemical indicators, the application of the working curve to assess the value of FS, APRI, FIB-4 index predict the degree of esophageal varices in patients with cirrhosis. Results: There was no esophageal varices in patients with cirrhosis. The values of FS in the mild, moderate and severe esophageal varices were (17.28 ± 7.67), (21.64 ± 7.67), (31.54 ± 3.68), (40.40 ± 6.46) k Pa. The FS value, APRI and FIB-4 in each group were significantly different (all P <0.05). FS value of light, moderate and severe esophageal varices predicted area under the curve were 0.854,0.917,0.924, the best diagnostic value was 26.2,30.9,34.4 kPa. The three under the curve of light, moderate and severe esophageal varices were 0.921,0.919,0.918. Conclusions: Compared with APRI, FIB-4 can better predict the degree of esophageal varices in patients with cirrhosis, and the combined application of FIB-4 may partially improve the diagnostic performance.