Chang Pik-Eu, Tan Chee-Kiat, Cheah Chang-Chuen, Li Weiquan, Chow Wan Cheng, Wong Yu-Jun
Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore.
Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore.
Dig Dis Sci. 2021 Apr;66(4):1343-1348. doi: 10.1007/s10620-020-06334-y. Epub 2020 May 21.
The expanded Baveno-VI criteria may further reduce the need for screening gastroscopy compared to Baveno-VI criteria.
We sought to validate the performance of these criteria in a cohort of compensated advanced chronic liver disease (cACLD) patients with predominantly hepatitis B infection.
Consecutive cACLD patients from 2006 to 2012 with paired liver stiffness measurements and screening gastroscopy within 1 year were included. The expanded Baveno-VI criteria were applied to evaluate the sensitivity (SS), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) for the presence of high-risk varices (HRV).
Among 165 cACLD patients included, 17 (10.3%) had HRV. The commonest etiology of cACLD was chronic hepatitis B (36.4%) followed by NAFLD (20.0%). Application of expanded Baveno-VI criteria avoided more screening gastroscopy (43.6%) as compared to the original Baveno-VI criteria (18.8%) without missing more HRV (1 with both criteria). The overall SS, SP, PPV and NPV of the expanded Baveno-VI criteria in predicting HRV were 94.1%, 48.0%, 17.2% and 98.6%, respectively.
Application of the expanded Baveno-VI criteria can safely avoid screening gastroscopy in 43.6% of cACLD patients with an excellent ability to exclude HRV.
与巴韦诺Ⅵ标准相比，扩展的巴韦诺Ⅵ标准可能进一步减少筛查胃镜的需求。
我们试图在以乙型肝炎感染为主的代偿期晚期慢性肝病（cACLD）患者队列中验证这些标准的性能。
纳入2006年至2012年连续的cACLD患者，这些患者在1年内进行了配对肝脏硬度测量和筛查胃镜检查。应用扩展的巴韦诺Ⅵ标准评估高危静脉曲张（HRV）存在的敏感性（SS）、特异性（SP）、阳性预测值（PPV）和阴性预测值（NPV）。
在纳入的165例cACLD患者中，17例（10.3%）有HRV。cACLD最常见的病因是慢性乙型肝炎（36.4%），其次是非酒精性脂肪性肝病（20.0%）。与原始巴韦诺Ⅵ标准（18.8%）相比，应用扩展的巴韦诺Ⅵ标准可避免更多的筛查胃镜检查（43.6%），且不会遗漏更多的HRV（两种标准均为1例）。扩展的巴韦诺Ⅵ标准预测HRV的总体SS、SP、PPV和NPV分别为94.1%、48.0%、17.2%和98.6%。
应用扩展的巴韦诺Ⅵ标准可安全地避免43.6%的cACLD患者进行筛查胃镜检查，且具有出色的排除HRV的能力。
