瞬时弹性成像及血清肝纤维化检测对肝硬化患者食管静脉曲张的临床诊断价值分析
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摘要
目的探讨瞬时弹性成像系统(Fibroscan)和血清肝纤维化检测对肝硬化患者食管静脉曲张(EV)的临床诊断价值。方法回顾性分析2014年2月至2017年2月于山西省人民医院门诊就诊或住院的肝硬化患者194例,均接受胃镜、Fibroscan及血清肝纤维化检查。根据是否发生EV分为无EV组(84例)和EV组(110例)。比较2组患者血清肝纤维化指标[透明质酸酶、层粘连蛋白(LN)、Ⅲ型前胶原(PⅢNP)、Ⅳ型胶原]和肝硬度值,分析血清透明质酸酶、LN、PⅢNP、Ⅳ型胶原和肝硬度值对肝硬化患者EV的诊断价值。结果无EV组血清透明质酸酶、LN、PⅢNP、Ⅳ型胶原和肝硬度值均明显低于EV组,差异均有统计学意义(均P <0. 05)。Fibroscan检测肝硬度值及血清透明质酸酶、PⅢNP、Ⅳ型胶原对肝硬化患者EV有一定预测价值(曲线下面积=0. 758、0. 742、0. 679、0. 640,95%置信区间:0. 690～0. 825、0. 673～0. 812、0. 604～0. 754、0. 562～0. 718,均P <0. 05),敏感度均达到0. 8及以上,而血清LN对肝硬化患者EV无明显预测价值(P=0. 311)。肝硬度值与血清透明质酸酶、LN、PⅢNP、Ⅳ型胶原均有相关性(r=0. 537、0. 282、0. 524、0. 408,均P <0. 001),其中肝硬度值与血清透明质酸酶、PⅢNP关系较密切,与Ⅳ型胶原低度相关,与LN关系不密切。结论 Fibroscan检测肝硬度值具有无创、可重复、便捷等特点,结合血清肝纤维化指标(透明质酸酶、PⅢNP、Ⅳ型胶原)综合评估,可作为筛选肝硬化患者EV的检查方法,具有很好的临床应用价值。
Objective To evaluate Fibroscan( transient elastography) and Fibrotest in the diagnosis of esophageal varices( EV) in patients with liver cirrhosis. Methods From February 2014 to February 2017,194 patients with liver cirrhosis were examined by gastroscopy,Fibroscan and Fibrotest in Shanxi Provincial People's Hospital. According to the comorbidity of EV,the patients were divided into non-EV group( 84 cases)and EV group( 110 cases). Liver fibrosis serum indicators including hyaluronidase( HA),laminin( LN),type Ⅲprocollagen( PⅢ NP),type Ⅳ collagen( Ⅳ-Col) and liver stiffness were detected. Diagnostic values of above factors were analyzed. Results Serum levels of HA,LN,PⅢNP,Ⅳ-Col and liver stiffness in non-EV group were significantly lower than those in EV group( P < 0. 05). Liver stiffness measured by Fibroscan,serum HA,PⅢNP and Ⅳ-Col levels showed high predictive values for EV( area under curve: 0. 758,0. 742,0. 679,0. 640;95% confidence interval: 0. 690-0. 825,0. 673-0. 812,0. 604-0. 754,0. 562-0. 718,all P < 0. 05); the sensitivities were greater than 0. 8; serum LN showed no significant relation with EV( P = 0. 311). Liver stiffness was positively correlated with the levels of HA,LN,PⅢNP and Ⅳ-Col( r = 0. 537,0. 282,0. 524,0. 408; all P < 0. 001).Conclusion Fibroscan is minimally invasive, repeatable and convenient for liver stiffness measurement;combined with Fibrotest,it shows great value in the diagnosis of EV in patients with liver cirrhosis.
Objective To evaluate Fibroscan( transient elastography) and Fibrotest in the diagnosis of esophageal varices( EV) in patients with liver cirrhosis. Methods From February 2014 to February 2017,194 patients with liver cirrhosis were examined by gastroscopy,Fibroscan and Fibrotest in Shanxi Provincial People's Hospital. According to the comorbidity of EV,the patients were divided into non-EV group( 84 cases)and EV group( 110 cases). Liver fibrosis serum indicators including hyaluronidase( HA),laminin( LN),type Ⅲprocollagen( PⅢ NP),type Ⅳ collagen( Ⅳ-Col) and liver stiffness were detected. Diagnostic values of above factors were analyzed. Results Serum levels of HA,LN,PⅢNP,Ⅳ-Col and liver stiffness in non-EV group were significantly lower than those in EV group( P < 0. 05). Liver stiffness measured by Fibroscan,serum HA,PⅢNP and Ⅳ-Col levels showed high predictive values for EV( area under curve: 0. 758,0. 742,0. 679,0. 640;95% confidence interval: 0. 690-0. 825,0. 673-0. 812,0. 604-0. 754,0. 562-0. 718,all P < 0. 05); the sensitivities were greater than 0. 8; serum LN showed no significant relation with EV( P = 0. 311). Liver stiffness was positively correlated with the levels of HA,LN,PⅢNP and Ⅳ-Col( r = 0. 537,0. 282,0. 524,0. 408; all P < 0. 001).Conclusion Fibroscan is minimally invasive, repeatable and convenient for liver stiffness measurement;combined with Fibrotest,it shows great value in the diagnosis of EV in patients with liver cirrhosis.
引文
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[18]Iwata Y,Enomoto H,Sakai Y,et al. Elevation of the AST to ALT ratio in association with the severity of esophageal varices in patients with HCV-related compensated liver cirrhosis[J]. Hepatogastroenterology,2013,60(121):149-152. DOI:10. 5754/hge12578.
[19]Salzl P,Reiberger T,Ferlitsch M,et al. Evaluation of portal hypertension and varices by acoustic radiation force impulse imaging of the liver compared to transient elastography and AST to platelet ratio index[J]. Ultraschall Med,2014,35(6):528-533.DOI:10. 1055/s-0034-1366506.
[20]冯洁,潘存伟,黄成军. APRI、AAR对肝硬化食管静脉曲张的诊断价值[J].现代消化及介入诊疗,2013,18(3):129-131. DOI:10. 3961/j. issn. 1672-2159. 2013. 03. 001.Feng J,Pan CW,Huang CJ. The diagnostic value of APRI and AAR for the esophageal varices in patient with cirrhosis[J].Modern Digestion&Intervention,2013,18(3):129-131. DOI:10. 3961/j. issn. 1672-2159. 2013. 03. 001.
[21]Tao R,Li X,Ran R,et al. A mixed analysis comparing nine minimally invasive surgeries for unresectable hepatocellular carcinoma patients[J]. Oncotarget,2017,8(3):5460-5473. DOI:10. 18632/oncotarget. 12348.
[2]de Franchis R,Baveno VI Faculty. Expanding consensus in portal hypertension:Report of the BavenoⅥConsensus Workshop:Stratifying risk and individualizing care for portal hypertension[J].J Hepatol,2015,63(3):743-752. DOI:10. 1016/j. jhep. 2015.05. 022.
[3]Moellering RE,Cornejo M,Davis TN,et al. Direct inhibition of the NOTCH transcription factor complex[J]. Nature, 2009,462(7270):182-188. DOI:10. 1038/nature08543.
[4]Serra MF,Anjos-Valotta EA,Olsen PC,et al. Nebulized lidocaine prevents airway inflammation,peribronchial fibrosis,and mucus production in a murine model of asthma[J]. Anesthesiology,2012,117(3):580-591. DOI:10. 1097/ALN. 0b013e31826687d5.
[5]Contreras-Cornejo H,Saucedo-Correa G,Oviedo-Boyso J,et al.The CSL proteins, versatile transcription factors and context dependent corepressors of the notch signaling pathway[J]. Cell Div,2016,11:12. DOI:10. 1186/s13008-016-0025-2.
[6]Roderburg C,Urban GW,Bettermann K,et al. Micro-RNA profiling reveals a role for miR-29 in human and murine liver fibrosis[J].Hepatology,2011,53(1):209-218. DOI:10. 1002/hep. 23922.
[7]Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension:variceal hemorrhage, ascites, and spontaneous bacterial peritonitis[J]. Gastroenterology, 2001,120(3):726-748. DOI:10. 1053/gast. 2001. 22580.
[8]Yan J. Analysis on effect of devascularization and endoscopic variceal ligation in treatment of patients with liver cirrhosis and esophageal variceal bleeding[J/CD]. Chin J Liver Dis:Electronic Edition,2017,9(1):50-53.
[9]王燕颖,禹晶,张秉全.肝硬化门静脉高压症食管胃静脉曲张的内镜诊断和治疗[J].中国临床医生,2013,41(8):3-5. DOI:10. 3969/j. issn. 1008-1089. 2013. 08. 002.Wang YY,Yu J,Zhang BQ. Endoscopic diagnosis and treatment of esophagogastric varices in cirrhotic portal hypertension[J].Chinese Journal for Clinicians,2013,41(8):3-5. DOI:10. 3969/j. issn. 1008-1089. 2013. 08. 002.
[10]Chiao YA,Ramirez TA,Zamilpa R,et al. Matrix metalloproteinase-9deletion attenuates myocardial fibrosis and diastolic dysfunction in ageing mice[J]. Cardiovasc Res,2012,96(3):444-455. DOI:10.1093/cvr/cvs275.
[11]Stefanescu H,Grigorescu M,Lupsor M,et al. Spleen stiffness measurement using Fibroscan for the noninvasive assessment of esophageal varices in liver cirrhosis patients[J]. J Gastroenterol Hepatol,2011,26(1):164-170. DOI:10. 1111/j. 1440-1746.2010. 06325. x.
[12]Foucher J,Chanteloup E,Vergniol J,et al. Diagnosis of cirrhosis by transient elastography(Fibro Scan):a prospective study[J].Gut,2006,55(3):403-408. DOI:10. 1136/gut. 2005. 069153.
[13]Foucher J,Castéra L,Bernard PH,et al. Prevalence and factors associated with failure of liver stiffness measurement using Fibro Scan in a prospective study of 2114 examinations[J]. Eur J Gastroenterol Hepatol,2006,18(4):411-412.
[14]袁平戈.瞬时弹性成像技术在肝癌预测、诊断中的应用[J].泸州医学院学报,2016,39(5):421-424. DOI:10. 3969/j. issn.1000-2669. 2016. 05. 008.Yuan PG. Application of transient elastography in prediction and diagnosis of liver cancer[J]. Journal of Luzhou Medical College,2016,39(5):421-424. DOI:10. 3969/j. issn. 1000-2669. 2016. 05. 008.
[15]沈斐斐,陆伦根.瞬时弹性成像技术在慢性肝病肝纤维化诊断中的应用进展[J].实用肝脏病杂志,2016,19(5):620-623.DOI:10. 3969/j. issn. 1672-5069. 2016. 05. 031.Shen FF,Lu LG. Noninvasive assessment of liver fibrosis by transient elastography in patients with chronic liver disease[J]. Journal of Practical Hepatology,2016,19(5):620-623. DOI:10. 3969/j.issn. 1672-5069. 2016. 05. 031.
[16]高庆梅,张玫.超声弹性成像技术及其临床应用[J].实用医药杂志,2014,31(1):79-81.Gao QM, Zhang M. Ultrasound elastography and its clinical application[J]. Practical Journal of Medicine&Pharmacy,2014,31(1):79-81.
[17]Sebastiani G,Tempesta D,Fattovich G,et al. Prediction of oesophageal varices in hepatic cirrhosis by simple serum non-invasive markers:Results of a multicenter,large-scale study[J]. J Hepatol,2010,53(4):630-638. DOI:10. 1016/j. jhep. 2010. 04. 019.
[18]Iwata Y,Enomoto H,Sakai Y,et al. Elevation of the AST to ALT ratio in association with the severity of esophageal varices in patients with HCV-related compensated liver cirrhosis[J]. Hepatogastroenterology,2013,60(121):149-152. DOI:10. 5754/hge12578.
[19]Salzl P,Reiberger T,Ferlitsch M,et al. Evaluation of portal hypertension and varices by acoustic radiation force impulse imaging of the liver compared to transient elastography and AST to platelet ratio index[J]. Ultraschall Med,2014,35(6):528-533.DOI:10. 1055/s-0034-1366506.
[20]冯洁,潘存伟,黄成军. APRI、AAR对肝硬化食管静脉曲张的诊断价值[J].现代消化及介入诊疗,2013,18(3):129-131. DOI:10. 3961/j. issn. 1672-2159. 2013. 03. 001.Feng J,Pan CW,Huang CJ. The diagnostic value of APRI and AAR for the esophageal varices in patient with cirrhosis[J].Modern Digestion&Intervention,2013,18(3):129-131. DOI:10. 3961/j. issn. 1672-2159. 2013. 03. 001.
[21]Tao R,Li X,Ran R,et al. A mixed analysis comparing nine minimally invasive surgeries for unresectable hepatocellular carcinoma patients[J]. Oncotarget,2017,8(3):5460-5473. DOI:10. 18632/oncotarget. 12348.