Llop Elba, Lopez Marta, de la Revilla Juan, Fernandez Natalia, Trapero Maria, Hernandez Marta, Fernández-Carrillo Carlos, Pons Fernando, Martinez Jose Luis, Calleja Jose Luis
Liver Unit, Hospital Universitario Puerta de Hierro, Madrid, Spain.
J Gastroenterol Hepatol. 2017 Nov;32(11):1867-1872. doi: 10.1111/jgh.13781.
The aim was to validate noninvasive methods to predict the presence of gastroesophageal varices (GEV) in patients with suspected compensated advanced chronic liver disease.
We retrospectively reviewed clinical and radiological data collected prospectively between September 2013 and September 2015. We reviewed 442 consecutive patients with suspected compensated advanced chronic liver disease measured by transient elastography (TE) and a gastroscopy. We evaluated platelets, spleen diameter, TE, liver stiffness × spleen size/platelets (LSPS), variceal risk index (VRI), Baveno VI strategy, and Augustin algorithm.
One hundred sixty-one out of 442 patients were included. Patients with GEV were compared with patients without GEV and showed statistically significant differences in platelet count (117 SD 51 vs 149 SD 62; P = 0.02), spleen diameter (13.0 SD 1.9 vs 11.5 SD 2; P = 0.003), and TE (28 SD 15 vs 19 SD 10; P = 0.001). Single methods (platelet count and TE) diagnosed correctly 51% and 71.4% of patients. Combined methods (LSPS, VRI, Baveno VI, and Augustin algorithm) diagnosed correctly 78%, 83.6%, 45.3%, and 57.1% of patients. Patients with GEV misdiagnosed: platelets 5/161 (3.1%), TE 6/161 (3.7%), LSPS 16/159 (10%), VRI 18/159 (11.3%), Baveno VI 3/161 (1.8%), and Augustin algorithm 6/161 (3.7%). Rate of unnecessary gastroscopies: platelets 46%, TE 25%, LSPS 13%, VRI 6%, Baveno VI 53%, and Augustin algorithm 39.1%.
A significant number of patients were classified correctly using TE, LSPS, and VRI; however, LSPS and VRI had unacceptable rates of misdiagnoses. TE is the best noninvasive single method and the Baveno VI strategy the best combined method.
目的是验证用于预测疑似代偿期晚期慢性肝病患者食管胃静脉曲张（GEV）存在情况的非侵入性方法。
我们回顾性分析了2013年9月至2015年9月前瞻性收集的临床和放射学数据。我们回顾了442例连续的疑似代偿期晚期慢性肝病患者，这些患者均接受了瞬时弹性成像（TE）检查和胃镜检查。我们评估了血小板、脾脏直径、TE、肝硬度×脾脏大小/血小板（LSPS）、静脉曲张风险指数（VRI）、Baveno VI策略和奥古斯丁算法。
442例患者中纳入了161例。将有GEV的患者与无GEV的患者进行比较，结果显示血小板计数（117±51对149±62；P = 0.02）、脾脏直径（13.0±1.9对11.5±2；P = 0.003）和TE（28±15对19±10；P = 0.001）存在统计学显著差异。单一方法（血小板计数和TE）正确诊断出的患者比例分别为51%和71.4%。联合方法（LSPS、VRI、Baveno VI和奥古斯丁算法）正确诊断出的患者比例分别为78%、83.6%、45.3%和57.1%。被误诊的有GEV的患者：血小板计数法5/161（3.1%），TE法6/161（3.7%），LSPS法16/159（10%），VRI法18/159（11.3%），Baveno VI法3/161（1.8%），奥古斯丁算法6/161（3.7%）。不必要的胃镜检查率：血小板计数法46%，TE法25%，LSPS法13%，VRI法6%，Baveno VI法53%，奥古斯丁算法39.1%。
使用TE、LSPS和VRI能正确分类相当数量的患者；然而，LSPS和VRI的误诊率令人难以接受。TE是最佳的非侵入性单一方法，Baveno VI策略是最佳的联合方法。
