Yan Yuling, Xing Xian, Lu Qiang, Wang Xiaoze, Luo Xuefeng, Yang Li
Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, People's Republic of China.
West China Hospital, Sichuan University-University of Oxford Huaxi Joint for Gastrointestinal Cancer Centre, People's Republic of China.
Expert Rev Gastroenterol Hepatol. 2022 Jan;16(1):89-96. doi: 10.1080/17474124.2022.2020644. Epub 2022 Jan 11.
To investigate the diagnostic performance of liver stiffness (LS) measured by 2D-SWE for predicting esophageal varices (EV) and high-risk varices (HRV) in patients with hepatitis B virus (HBV)-related compensated advanced chronic liver disease (cACLD).
In total, 268 patients with HBV-related cACLD who underwent 2D-SWE and esophagogastroduodenoscopy (EGD) were retrospectively evaluated. The new criteria for ruling out HRV were tested in the training cohort with 175 patients and validated in the validation cohort with 93 patients.
The AUROCs of LS for predicting EV and HRV were 0.90(0.86-0.95) and 0.93(0.89-0.96) respectively. LS (OR, 1.64 (95% CI: 1.31-2.07); P < 0.0001), PLT (OR, 0.94 (95% CI: 0.91-0.97); P < 0.0001) and albumin (OR, 0.75 (95% CI: 0.62-0.90); P = 0.02) were independent factors for the presence of HRV. The Baveno VI criteria of LS < 20 kPa and PLT > 150 × 10 /L saved 15.1%-17.1% EGD screening with 0-4.3% HRV miss rate. LS < 16 kPa and PLT > 60 × 10 /L spared 51.4%-52.7% EGD screening with 3.8%-4.3% HRV miss rate.
Baveno VI criteria is suitable for 2D-SWE to rule out HRV. LS < 16 kPa and PLT > 60 × 10 /L could be a reliable model for ruling out HRV in patients with HBV-related cACLD.
探讨二维剪切波弹性成像（2D-SWE）测量的肝脏硬度（LS）对预测乙型肝炎病毒（HBV）相关代偿期晚期慢性肝病（cACLD）患者食管静脉曲张（EV）和高危静脉曲张（HRV）的诊断性能。
回顾性评估268例接受2D-SWE和食管胃十二指肠镜检查（EGD）的HBV相关cACLD患者。在175例患者的训练队列中测试排除HRV的新标准，并在93例患者的验证队列中进行验证。
LS预测EV和HRV的曲线下面积（AUROC）分别为0.90（0.86-0.95）和0.93（0.89-0.96）。LS（比值比[OR]，1.64[95%置信区间（CI）：1.31-2.07]；P<0.0001）、血小板计数（PLT）（OR，0.94[95%CI：0.91-0.97]；P<0.0001）和白蛋白（OR，0.75[95%CI：0.62-0.90]；P=0.02）是HRV存在的独立因素。LS<20 kPa且PLT>150×10⁹/L的Baveno VI标准可节省15.1%-17.1%的EGD筛查，HRV漏诊率为0-4.3%。LS<16 kPa且PLT>60×10⁹/L可节省51.4%-52.7%的EGD筛查，HRV漏诊率为3.8%-4.3%。
Baveno VI标准适用于2D-SWE排除HRV。LS<16 kPa且PLT>60×10⁹/L可能是排除HBV相关cACLD患者HRV的可靠模型。
