Department of Infectious Disease, Nanfang Hospital, Guangzhou, China.
J Gastroenterol Hepatol. 2012 Mar;27(3):533-9. doi: 10.1111/j.1440-1746.2011.06889.x.
The aim of this study was to evaluate the clinical value of transient elastography (TE) for high-risk esophageal varices (HREV) prediction in hepatitis-B-related cirrhosis patients.
A total of 238 patients with hepatitis B cirrhosis were prospectively enrolled. All patients had undergone TE and upper gastrointestinal endoscopy. Diagnostic value was assessed by the area under ROC curve (AUROC), predictive value and likelihood ratio.
The size of esophageal varices correlated with liver stiffness with Kendall's tau_b 0.236 overall and 0.425 in patients with ALT ≥ 5 × upper limit of normal (ULN). The AUROC of TE predicting HREV was 0.73 (95% confidence interval 0.66-0.80) overall and 0.92 (0.82-1.01) for patients with ALT ≥ 5 × ULN. In patients with ALT ≥ 5 × ULN, cut-off 36.1 kPa predicted HREV with a 100% negative predictive value (NPV), an indefinite negative likelihood ratio (NLR), a 72.7% positive predictive value (PPV) and a positive likelihood ratio (PLR) of 9.3. The AUROC of HREV-predicting model, constructed by ultrasonography and TE (USLS), was 0.84 (0.77-0.90) in the training set and 0.85 (0.76-0.94) in the validating set. Cut-off 3.30 excluded HREV with NPV 0.946 and NLR 0.10, and cut-off 5.98 determined HREV with PPV 0.870 and PLR 10.24. Using USLS, nearly 50% of patients could avoid endoscopic screening. The model's predictive values were maintained at similar accuracy in the validation set. Differences of AUROC in USLS, liver stiffness/spleen diameter to platelet ratio score and ultrasonic score were not significant.
TE may predict HREV in patients with ALT ≥ 5 × ULN. Overall, the clinical values of TE and USLS for HREV prediction should be evaluated by further studies.
本研究旨在评估瞬时弹性成像（TE）在乙型肝炎相关肝硬化患者高危食管静脉曲张（HREV）预测中的临床价值。
前瞻性纳入 238 例乙型肝炎肝硬化患者。所有患者均行 TE 和上消化道内镜检查。通过 ROC 曲线下面积（AUROC）、预测值和似然比评估诊断价值。
食管静脉曲张大小与肝硬度呈正相关，Kendall's tau_b 总体为 0.236，丙氨酸氨基转移酶（ALT）≥5×正常值上限（ULN）者为 0.425。TE 预测 HREV 的 AUROC 总体为 0.73（95%置信区间 0.66-0.80），ALT≥5×ULN 者为 0.92（0.82-1.01）。在 ALT≥5×ULN 者中，截断值 36.1 kPa 预测 HREV 的阴性预测值（NPV）为 100%，不确定的负似然比（NLR）为 0.10，阳性预测值（PPV）为 72.7%，阳性似然比（PLR）为 9.3。超声和 TE（USLS）构建的 HREV 预测模型在训练集中的 AUROC 为 0.84（0.77-0.90），在验证集中为 0.85（0.76-0.94）。截断值 3.30 排除 HREV 的 NPV 为 0.946，NLR 为 0.10，截断值 5.98 确定 HREV 的 PPV 为 0.870，PLR 为 10.24。使用 USLS，近 50%的患者可以避免内镜筛查。该模型在验证集中的预测值仍保持较高的准确性。USLS、肝硬度/脾直径与血小板比值评分和超声评分的 AUROC 差异无统计学意义。
TE 可预测 ALT≥5×ULN 的患者发生 HREV。总的来说，TE 和 USLS 预测 HREV 的临床价值需要进一步研究来评估。
