Gastroenterology, Queen's University, Kingston, Ontario, Canada.
J Viral Hepat. 2011 Apr;18(4):e75-80. doi: 10.1111/j.1365-2893.2010.01375.x. Epub 2010 Oct 7.
The diagnosis of cirrhosis requires screening for oesophageal varices by upper gastrointestinal endoscopy. In many countries, serological tests and elastography are replacing liver biopsy for diagnosing cirrhosis. The aims of this study were to see whether there was an optimal cut-off of liver stiffness that could predict the presence of large (>F2) oesophageal varices and whether this was disease specific. A total of two hundred and twenty-two patients with all cause cirrhosis (Child class A) were screened, and 211 had successful elastography and are included in the analysis. Of the patients studied, one hundred and thirty-two patients had no or small F1 varices and 79 had large varices. Liver stiffness of 19.8 kPa had a negative predictive value of 91% and a positive predictive value of 55% with an area under the curve (AUC) on receiver operating characteristics (ROC) of 0.73 in differentiating between small and large varices. Seven patients with large varices would have been incorrectly classified. In the 157 patients with hepatitis C as the aetiology of cirrhosis, the negative predictive value was 98% and only one patient was misclassified. Liver stiffness was superior in diagnostic accuracy to platelet count in all patients. A liver stiffness of >19.8 kPa could be utilized as a cut-off for endoscopy and beta blocker utilization, particularly in patients with hepatitis C.
肝硬化的诊断需要通过上消化道内窥镜检查筛查食管静脉曲张。在许多国家，血清学检测和弹性成像正在取代肝活检用于诊断肝硬化。本研究的目的是确定是否存在一个最佳的肝硬度截断值可以预测大（> F2）食管静脉曲张的存在，以及是否具有疾病特异性。总共筛选了 222 例各种病因引起的肝硬化（Child 分级 A）患者，其中 211 例成功进行了弹性成像，纳入分析。在所研究的患者中，132 例患者无小 F1 静脉曲张，79 例患者有大静脉曲张。肝硬度为 19.8 kPa 时，在鉴别小和大静脉曲张方面，其阴性预测值为 91%，阳性预测值为 55%，曲线下面积（AUC）在接受者操作特征（ROC）上为 0.73。7 例大静脉曲张患者的分类会不正确。在 157 例丙型肝炎引起的肝硬化患者中，阴性预测值为 98%，只有 1 例患者被错误分类。在所有患者中，肝硬度在诊断准确性方面均优于血小板计数。肝硬度> 19.8 kPa 可作为内镜和β受体阻滞剂使用的截断值，尤其是在丙型肝炎患者中。
