REACH-HCV 标准用于监测 HCV 根治后代偿期肝硬化患者低危食管静脉曲张的进展：SIMPLE 研究：SIMPLE：低危食管静脉曲张进展监测评分指数。
RESIST-HCV Criteria to Monitor Progression of Low-Risk Esophageal Varices in Patients With Compensated Cirrhosis After HCV Eradication: The SIMPLE Study: SIMPLE: Scoring Index to Monitor Progression of Low-risk Esophageal varices.
机构信息
Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Italy.
Department of Surgical, Oncological and Oral Sciences (Di.Chir, On.S.), University of Palermo, Italy.
出版信息
Am J Gastroenterol. 2022 Nov 1;117(11):1816-1824. doi: 10.14309/ajg.0000000000001878. Epub 2022 Jul 21.
INTRODUCTION
Noninvasive criteria to predict the progression of low-risk esophageal varices (EV) in patients with compensated hepatitis C virus (HCV) cirrhosis after sustained virological response (SVR) by direct-acting antivirals (DAAs) are lacking. Our aim was to assess the diagnostic performance of Rete Sicilia Selezione Terapia-HCV (RESIST-HCV) criteria for EV progression compared with elastography-based criteria (Baveno VI, Expanded Baveno VI, and Baveno VII-HCV criteria).
METHODS
All consecutive patients observed at 3 referral centers with compensated HCV cirrhosis with or without F1 EV who achieved sustained virological response by DAAs were classified at last esophagogastroduodenoscopy (EGDS) as RESIST-HCV low risk (i.e., low probability of high-risk varices [HRV]) if platelets were >120 × 10 9 /L and serum albumin >3.6 g/dL or RESIST-HCV high risk (i.e., high probability of HRV) if platelets were <120 × 10 9 /L or serum albumin <3.6 g/dL. The primary outcome was the progression to HRV. The area under the receiver operating characteristic curve and decision curve analysis of noninvasive criteria were calculated.
RESULTS
The cohort consisted of 353 patients in Child-Pugh class A (mean age 67.2 years, 53.8% males). During a mean follow-up of 44.2 months, 34 patients (9.6%, 95% CI 6.7%-13.5%) developed HRV. At the last EGDS, 178 patients (50.4%) were RESIST-low risk, and 175 (49.6%) were RESIST-high risk. RESIST-HCV criteria showed the highest area under the receiver operating characteristic curve (0.70, 95% confidence interval 0.65-0.75), correctly sparing the highest number of EGDS (54.3%), with the lowest false-positive rate (45.7%), compared with elastography-based criteria. Decision curve analysis showed that RESIST-HCV had higher clinical utility than elastography-based criteria.
DISCUSSION
Biochemical-based RESIST-HCV criteria are useful to easily predict HRV development after HCV eradication by DAAs in patients with compensated cirrhosis and low-risk EV.
简介
直接作用抗病毒药物 (DAAs) 治疗后获得持续病毒学应答 (SVR) 的代偿性丙型肝炎病毒 (HCV) 肝硬化患者中，缺乏预测低危食管静脉曲张 (EV) 进展的非侵入性标准。我们的目的是评估 Rete Sicilia Selezione Terapia-HCV (RESIST-HCV) 标准与基于弹性成像的标准（Baveno VI、扩展 Baveno VI 和 Baveno VII-HCV 标准）相比，对 EV 进展的诊断性能。
方法
在 3 家转诊中心观察到的所有伴有或不伴有 F1 EV 的代偿性 HCV 肝硬化患者，在接受 DAA 治疗后获得持续病毒学应答，根据最后一次食管胃十二指肠镜检查 (EGDS) 将 RESIST-HCV 低危 (即低危静脉曲张 [HRV] 概率) 分类，如果血小板 >120×109/L 和血清白蛋白 >3.6 g/dL 或 RESIST-HCV 高危 (即 HRV 高概率) 如果血小板 <120×109/L 或血清白蛋白 <3.6 g/dL。主要结局是进展为 HRV。计算非侵入性标准的受试者工作特征曲线下面积和决策曲线分析。
结果
队列由 353 名 Child-Pugh 分级为 A 的患者组成（平均年龄 67.2 岁，53.8%为男性）。在平均 44.2 个月的随访期间，34 名患者（9.6%，95%CI 6.7%-13.5%）发生 HRV。在最后一次 EGDS 时，178 名患者（50.4%）为 RESIST-低危，175 名患者（49.6%）为 RESIST-高危。RESIST-HCV 标准显示出最高的受试者工作特征曲线下面积（0.70，95%置信区间 0.65-0.75），正确避免了最高数量的 EGDS（54.3%），假阳性率最低（45.7%），与基于弹性成像的标准相比。决策曲线分析表明，与基于弹性成像的标准相比，RESIST-HCV 具有更高的临床实用性。
讨论
基于生化的 RESIST-HCV 标准可用于在接受 DAA 治疗后获得持续病毒学应答的代偿性肝硬化和低危 EV 患者中，轻松预测 HCV 根除后 HRV 的发生。
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