Tu C H, Li J, Wang C Y, Zhou L, Ma Y, Gao M, Wang J, Zeng Q M, Lu W
Graduate School of Tianjin Medical University, Tianjin 300070, China.
Tianjin Second People's Hospital, Tianjin Hepatopathy Research Institute, Tianjin 300192, China.
Zhonghua Gan Zang Bing Za Zhi. 2019 Aug 20;27(8):615-620. doi: 10.3760/cma.j.issn.1007-3418.2019.08.006.
To investigate the diagnostic value of endoscopic ultrasonography (EUS), Fibroscan, acoustic radiation force impulse (ARFI), and aspartate aminotransferase-to-platelet ratio (APRI) and their combination for early stage liver cirrhosis. Three hundred and twenty-two hospitalized patients who had been diagnosed with chronic viral liver disease from March 2016 to April 2018 were included. According to the clinical diagnosis, patients were divided into chronic hepatitis and the early stage liver cirrhosis group (Child-Pugh A grade). All patients were examined by Fibroscan to detect liver stiffness measurement (LSM), ARFI to detect liver virtual touch tissue quantification (VTQ) value, esophagogastroduodenoscopy and EUS to detect esophagogastric varices, laboratory and imaging examination. The index of EUS, Fibroscan, ARFI, and APRI was analyzed and the regression model was established by binary logistic regression, and the diagnostic efficacy of the above index and regression model for early stage of cirrhosis was evaluated by the area under a receiver operating characteristic curve (AUROCs). An early stage cirrhosis group had significantly higher detection rate with EUS (esophagogastric varices), Fibroscan (LSM), ARFI (VTQ) and APRI than chronic hepatitis group [76.7% vs. 10.7%, 10.4 (7.8, 17.3) vs. 6.1 (5.2, 8.4) kPa, 1.71(1.48, 2.07) m/s vs. 1.25(1.14, 1.43) m/s and 0.65 (0.38, 1.15) vs. 0.38(0.26, 0.62), respectively]. The corresponding chi-square test were 140.86, = -9.069, = -9.948 and = -5.764, respectively and the differences were statistically significant ( < 0.01). The areas under the receiver operating characteristic curve and regression model were 0.830 (0.783 ~ 0.877), 0.793 (0.744 ~ 0.841), 0.821 (0.775 ~ 0.868), 0.686 (0.628 ~ 0.744) and 0.947 (0.925 ~ 0.969) for the diagnosis of early stage cirrhosis, respectively. Among them, the regression model of three indices (EUS, LSM and VTQ) had the largest AUROCs (0.947) and the corresponding sensitivity and specificity were 0.878 and 0.867, respectively. The combination of EUS, LSM and ARFI had a superior diagnostic value for early stage liver cirrhosis, and may improve the diagnosis rate and reduce the misdiagnosis rate.
探讨内镜超声检查（EUS）、Fibroscan、声辐射力脉冲（ARFI）及天冬氨酸氨基转移酶与血小板比值（APRI）及其联合检测对早期肝硬化的诊断价值。纳入2016年3月至2018年4月期间确诊为慢性病毒性肝病的322例住院患者。根据临床诊断，将患者分为慢性肝炎组和早期肝硬化组（Child-Pugh A级）。所有患者均接受Fibroscan检测肝脏硬度值（LSM）、ARFI检测肝脏虚拟触诊组织定量（VTQ）值、食管胃十二指肠镜及EUS检测食管胃静脉曲张，以及实验室和影像学检查。分析EUS、Fibroscan、ARFI及APRI各项指标，并采用二元逻辑回归建立回归模型，通过受试者工作特征曲线下面积（AUROCs）评估上述指标及回归模型对早期肝硬化的诊断效能。早期肝硬化组EUS（食管胃静脉曲张）、Fibroscan（LSM）、ARFI（VTQ）及APRI的检测率显著高于慢性肝炎组[分别为76.7%对10.7%，10.4（7.8，17.3）对6.1（5.2，8.4）kPa，1.71（1.48，2.07）m/s对1.25（1.14，1.43）m/s，0.65（0.38，1.15）对0.38（0.26，0.62）]。相应的卡方检验分别为140.86、=-9.069、=-9.948及=-5.764，差异均有统计学意义（<0.01）。受试者工作特征曲线及回归模型诊断早期肝硬化的曲线下面积分别为0.830（0.7830.877）、0.793（0.7440.841）、0.821（0.7750.868）、0.68（0.6280.744）及0.947（0.925~0.969）。其中，三项指标（EUS、LSM及VTQ）的回归模型AUROCs最大（0.947），相应的敏感度和特异度分别为0.878和0.867。EUS、LSM及ARFI联合检测对早期肝硬化具有较高的诊断价值，可提高诊断率并降低误诊率。
