Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
Department of Infectious Disease, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
Biomed Res Int. 2021 Apr 7;2021:6635963. doi: 10.1155/2021/6635963. eCollection 2021.
Baveno VI criteria, based on liver stiffness (LS) measured by transient elastography and platelet counts (PLT), have been proposed to avoid unnecessary endoscopy screening for high-risk varices (HRVs). However, the cut-off value of LS measured by 2D-SWE and PLT to predict HRVs in compensated hepatitis B-related cirrhotic patients remains unknown.
To prospectively analyze the cut-off of the combination of LS measured by 2D-SWE and PLT in predicting HRVs and the influence of antiviral therapies in its efficacy.
Serum parameters, LS, and endoscopy results were obtained from 160 compensated hepatitis B-related cirrhotic patients. The accuracy of the combined algorithm was assessed in the whole cohort and subgroups with or without consecutive antiviral therapies in the past 6 months.
In the whole cohort, the optimal cut-off value of LS for HRVs was 14.5 kPa. Patients with a LS value < 14.5 kPa with a PLT value > 110 × 10/L can be excluded from HRVs (NPV = 0.99, endoscopy saved rates = 0.68). Conversely, a LS value of ≥14.5 kPa and a PLT value of ≤110 × 10/L indicated HRVs, with accurate rates of 82.35%, and 10.63% of patients can avoid additional endoscopy screening. Moreover, antiviral therapy had no significant effect on the accuracy and rates saved from further endoscopy screening, when comparing patients with or without antiviral therapies (all values > 0.05).
The combination of LS (14.5 kPa) measured by 2D-SWE and PLT (110 × 10/L) can predict HRVs accurately in compensated hepatitis B-related cirrhotic patients without significant interference of antiviral therapy histories.
基于瞬时弹性成像测量的肝硬度（LS）和血小板计数（PLT）的 Baveno VI 标准，已被提议用于避免对高危静脉曲张（HRV）进行不必要的内镜筛查。然而，二维剪切波弹性成像（2D-SWE）测量的 LS 与 PLT 联合预测代偿性乙型肝炎相关肝硬化患者 HRV 的截断值仍不清楚。
前瞻性分析 2D-SWE 测量的 LS 与 PLT 联合预测 HRV 的截断值及其对抗病毒治疗疗效的影响。
从 160 例代偿性乙型肝炎相关肝硬化患者中获得血清参数、LS 和内镜结果。在整个队列中评估了联合算法的准确性，并在过去 6 个月内有或没有连续抗病毒治疗的亚组中评估了其准确性。
在整个队列中，LS 预测 HRV 的最佳截断值为 14.5kPa。LS 值<14.5kPa 且 PLT 值>110×10/L 的患者可以排除 HRV（NPV=0.99，内镜节省率=0.68）。相反，LS 值≥14.5kPa 且 PLT 值≤110×10/L 提示 HRV，其准确率分别为 82.35%和 10.63%，可避免额外的内镜筛查。此外，比较有或无抗病毒治疗的患者时，抗病毒治疗对准确性和避免进一步内镜筛查的比率均无显著影响（所有 值>0.05）。
2D-SWE 测量的 LS（14.5kPa）与 PLT（110×10/L）联合可准确预测代偿性乙型肝炎相关肝硬化患者的 HRV，且抗病毒治疗史无显著干扰。
