Pineda Juan A, Recio Eva, Camacho Angela, Macías Juan, Almodóvar Carmen, González-Serrano Mercedes, Merino Dolores, Tellez Francisco, Ríos Maria José, Rivero Antonio
Unit of Infectious Diseases, Hospital Universitario de Valme, Seville, Spain.
J Acquir Immune Defic Syndr. 2009 Aug 1;51(4):445-9. doi: 10.1097/QAI.0b013e3181acb675.
Liver stiffness (LS) measured by transient elastometry is associated with portal pressure in hepatitis C virus (HCV)-monoinfected patients and could predict the presence of esophageal varices in these subjects. The aim of this study was to assess the ability of LS to predict esophageal varices requiring preventive therapy for bleeding in HIV/HCV-coinfected patients.
One hundred two HIV/HCV-coinfected patients with liver cirrhosis (LS >or= 14 kPa) underwent an upper gastrointestinal endoscopy (UGE) examination. The diagnostic performance of LS for esophageal varices requiring therapy (>or=F2 or F1 with red signs or Child-Pugh-Turcotte class C) was assessed by receiver operating receptor characteristic curves.
Nineteen patients (19%) harbored varices requiring therapy. LS in patients with and without varices needing treatment was 48 (33-71) kPa and 32 (18-48) kPa (P = 0.004). The area under the receptor operating characteristic curve (95% confidence interval) of LS for the occurrence of varices that should be treated was 0.71 (0.60 to 0.82). There was no cutoff level of LS with good positive predictive value for the presence of varices requiring therapy, but LS of 21 kPa had a negative predictive value of 100%. Twenty-six percent of patients with LS measurement and UGE showed LS <21 KPa.
LS is higher in HIV/HCV-coinfected patients with cirrhosis who show esophageal varices requiring therapy than in those who do not. A cutoff value of LS of 21 kPa could be useful to identify patients with very low probability of varices at risk for bleeding. UGE for screening could be spared in these patients until LS increases above 21 kPa.
通过瞬时弹性成像测量的肝脏硬度（LS）与丙型肝炎病毒（HCV）单一感染患者的门静脉压力相关，并且可以预测这些患者食管静脉曲张的存在。本研究的目的是评估LS预测HIV/HCV合并感染患者中需要进行预防性出血治疗的食管静脉曲张的能力。
102例HIV/HCV合并感染的肝硬化患者（LS≥14 kPa）接受了上消化道内镜检查（UGE）。通过受试者操作特征曲线评估LS对需要治疗的食管静脉曲张（≥F2或伴有红色征的F1或Child-Pugh-Turcotte C级）的诊断性能。
19例患者（19%）存在需要治疗的静脉曲张。有和没有需要治疗的静脉曲张的患者的LS分别为48（33-71）kPa和32（18-48）kPa（P = 0.004）。LS对于应治疗的静脉曲张发生的受试者操作特征曲线下面积（95%置信区间）为0.71（0.60至0.82）。对于需要治疗的静脉曲张的存在，没有具有良好阳性预测价值的LS临界值，但LS为21 kPa时具有100%的阴性预测价值。26%进行了LS测量和UGE检查的患者的LS<21 kPa。
有需要治疗的食管静脉曲张的HIV/HCV合并感染的肝硬化患者的LS高于没有此类静脉曲张的患者。LS临界值为21 kPa可能有助于识别静脉曲张出血风险极低的患者。在这些患者的LS升高至21 kPa以上之前，可以不进行用于筛查的UGE检查。
