Digestive Disease Service, Hospital Universitario 12 de Octubre, Madrid, Spain.
Digestive Disease Service, Hospital Universitario 12 de Octubre, Madrid, Spain.
Gastroenterol Hepatol. 2021 Apr;44(4):269-276. doi: 10.1016/j.gastrohep.2020.09.001. Epub 2020 Oct 21.
The aim of this study was to investigate the accuracy of liver and spleen stiffness measurement by transient elastography for the prediction of gastroesophageal varices in patients with HCV-associated cirrhosis treated with new direct-acting antiviral agents.
This cross-sectional observational study included patients with compensated HCV-related cirrhosis and sustained virological response after direct-acting antiviral therapy. Patients underwent liver and spleen stiffness measurement, abdominal ultrasound and oesophago-gastroduodenoscopy. Clinical and laboratory data and non-invasive markers such as the liver stiffness-spleen diameter to platelet ratio score, variceal risk index and platelet count to spleen diameter ratio were analyzed.
Ninety-seven consecutive patients were included. Liver stiffness measurement (12.2 vs 16; p=0.02), spleen stiffness measurement (39.4 vs 46.05; p=0.04), liver stiffness-spleen diameter to platelet ratio score (1.21 vs 2.02; p=0.008), platelet count to spleen diameter ratio (1102.19 vs 829.7; p=0.04) and variceal risk index (-3.4 vs -1.02; p=0.01) showed significant differences between patients without/with gastroesophageal varices. The best cut-off value to discard the presence of gastroesophageal varices was 12.3kPa for liver stiffness measurement and 27kPa for spleen stiffness measurement. However, diagnostic accuracy was moderate (AUROC: 0.671 and 0.624 respectively). Combining different non-invasive parameters did not significantly improve the overall performance.
Liver and spleen stiffness measurement showed suboptimal results for non-invasive assessment of gastroesophageal varices in HCV cirrhotic patients treated with direct-acting antiviral agents. Our results suggest that non-invasive methods cannot substitute standard procedures for predicting gastroesophageal varices in this population.
本研究旨在探讨瞬时弹性成像技术测量肝脏和脾脏硬度在预测接受新型直接作用抗病毒药物治疗的丙型肝炎相关肝硬化患者胃食管静脉曲张中的准确性。
这是一项横断面观察性研究，纳入了代偿性丙型肝炎相关肝硬化和直接作用抗病毒治疗后持续病毒学应答的患者。所有患者均行肝脏和脾脏硬度测量、腹部超声和胃镜检查。分析临床和实验室数据以及非侵入性标志物，如肝脏硬度-脾脏直径血小板比值评分、静脉曲张风险指数和血小板计数与脾脏直径比值。
共纳入 97 例连续患者。肝脏硬度测量值（12.2 与 16；p=0.02）、脾脏硬度测量值（39.4 与 46.05；p=0.04）、肝脏硬度-脾脏直径血小板比值评分（1.21 与 2.02；p=0.008）、血小板计数与脾脏直径比值（1102.19 与 829.7；p=0.04）和静脉曲张风险指数（-3.4 与-1.02；p=0.01）在无/有胃食管静脉曲张的患者之间存在显著差异。排除胃食管静脉曲张存在的最佳截断值为肝脏硬度测量 12.3kPa 和脾脏硬度测量 27kPa。然而，诊断准确性为中等（AUROC：分别为 0.671 和 0.624）。联合使用不同的非侵入性参数并不能显著提高整体性能。
在接受直接作用抗病毒药物治疗的丙型肝炎肝硬化患者中，肝脏和脾脏硬度测量对胃食管静脉曲张的非侵入性评估结果不佳。我们的结果表明，在该人群中，非侵入性方法不能替代标准程序来预测胃食管静脉曲张。
