Iwata Yoshinori, Enomoto Hirayuki, Sakai Yoshiyuki, Aizawa Nobuhiro, Tanaka Hironori, Ikeda Naoto, Takashima Tomoyuki, Ishii Akio, Hasegawa Kunihiro, Yuri Yukihisa, Iwata Kazunari, Saito Masaki, Imanishi Hiroyasu, lijima Hiroko, Nishiguchi Shuhei
Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
Hepatogastroenterology. 2013 Jan-Feb;60(121):149-52. doi: 10.5754/hge12578.
BACKGROUND/AIMS: The development of esophageal varices depends on the progression of liver fibrosis. However, it has not yet been sufficiently clarified whether biomarkers of liver fibrosis can be used to predict the incidence of varices in cirrhotic patients with a well-maintained liver function (Child-Pugh class A).
Three established markers of liver fibrosis, including AST-to-ALT ratios (AAR), FIB-4 and AST-to-platelet ratio indices (APRI), were analyzed in HCV-positive cirrhotic patients with Child-Pugh class A status, and the relationships between these markers and the risk of variceal bleeding were investigated.
The values of AAR and FIB-4 in the patient with varices with a high risk of hemorrhage were significantly higher than those in the patients without high-risk varices, whereas the value of APRI was not found to be related to the risk of variceal bleeding. Of all the parameters examined, the values of AAR were the most significantly different between the two (with or without high-risk varices) groups. In addition, the values of AAR increased in line with variceal severity.
The value of AAR is related to the severity and risk of variceal bleeding in patients with HCV-related compensated cirrhosis.
背景/目的：食管静脉曲张的发展取决于肝纤维化的进展。然而，肝功能维持良好（Child-Pugh A级）的肝硬化患者中，肝纤维化生物标志物能否用于预测静脉曲张的发生率，目前尚未得到充分阐明。
对Child-Pugh A级的丙型肝炎病毒（HCV）阳性肝硬化患者分析了三种已确立的肝纤维化标志物，包括天冬氨酸氨基转移酶与丙氨酸氨基转移酶比值（AAR）、FIB-4和天冬氨酸氨基转移酶与血小板比值指数（APRI），并研究了这些标志物与静脉曲张出血风险之间的关系。
出血风险高的静脉曲张患者的AAR和FIB-4值显著高于无高危静脉曲张的患者，而APRI值与静脉曲张出血风险无关。在所有检查参数中，两组（有或无高危静脉曲张）之间AAR值差异最为显著。此外，AAR值随静脉曲张严重程度增加而升高。
AAR值与HCV相关代偿期肝硬化患者静脉曲张出血的严重程度和风险相关。
