Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Liver Int. 2018 Aug;38(8):1442-1448. doi: 10.1111/liv.13732. Epub 2018 Mar 25.
BACKGROUND & AIMS: The Baveno VI and the expanded Baveno VI criteria were proposed to help identify patients who could safely avoid screening endoscopies for clinically significant varices among patients with compensated advanced chronic liver disease. However, these criteria require cross-validation, especially in Asian populations where the aetiologies of liver disease are different.
A total of 1035 patients, including 282 patients with compensated advanced chronic liver disease of different aetiology, were analysed. The compensated advanced chronic liver disease was defined by liver stiffness measurement ≥10 kPa, Child-Pugh class A and absence of prior liver decompensation. High-risk varix was defined as a grade ≥2 oesophageal varix, any varix with a red colour sign or gastric varices.
High-risk varixs were present in 19.5% (55/282 patients) with compensated advanced chronic liver disease. Among compensated advanced chronic liver disease patients, the expanded criteria could spare more endoscopies (51.7%) than the original criteria (27.6%). However, the expanded criteria missed a greater number of high-risk varixs (6.8%) than the original criteria (3.8%). When stratified according to liver disease aetiology, the negative predictive values for the original Baveno VI criteria were 0.92, 1.00, 1.00 and 1.00, and the negative predictive values for the expanded criteria were 0.92, 0.96, 0.92 and 0.93 for hepatitis B, hepatitis C, alcohol and non-alcoholic fatty liver disease, respectively. High-risk varixs were rarely detected in patients without compensated advanced chronic liver disease (1.1%, 8/753 patients).
In this Asian cohort study, the Baveno VI criteria were able to identify who could safely avoid screening endoscopy. The expanded Baveno VI criteria could spare more endoscopies but also could increase the odds of missing a high-risk varix.
Baveno VI 标准和扩展 Baveno VI 标准的提出是为了帮助确定代偿期肝硬化患者中，能够安全避免临床显著静脉曲张筛查的患者。然而，这些标准需要交叉验证，尤其是在亚洲人群中，肝脏疾病的病因不同。
共分析了 1035 例患者，包括 282 例不同病因的代偿期肝硬化患者。代偿期肝硬化的定义为肝硬度测量值≥10kPa、Child-Pugh 分级为 A 级且无既往肝失代偿。高危静脉曲张定义为≥2 级食管静脉曲张、任何红色征静脉曲张或胃静脉曲张。
282 例代偿期肝硬化患者中，高危静脉曲张占 19.5%（55/282 例）。在代偿期肝硬化患者中，扩展标准比原始标准（27.6%）可以节省更多的内镜检查（51.7%）。然而，扩展标准漏诊的高危静脉曲张（6.8%）比原始标准（3.8%）更多。根据肝脏疾病病因分层，原始 Baveno VI 标准的阴性预测值分别为 0.92、1.00、1.00 和 1.00，扩展标准的阴性预测值分别为乙型肝炎、丙型肝炎、酒精和非酒精性脂肪性肝病的 0.92、0.96、0.92 和 0.93。在无代偿期肝硬化的患者中，高危静脉曲张很少被发现（1.1%，8/753 例）。
在这项亚洲队列研究中，Baveno VI 标准能够识别出可以安全避免内镜筛查的患者。扩展的 Baveno VI 标准可以节省更多的内镜检查，但也可能增加漏诊高危静脉曲张的风险。
