在代偿期晚期肝细胞疾病（cALCD）患者中，脾硬度测量联合肝硬度测量与Baveno VII标准在预测食管和胃静脉曲张存在方面的比较
Splenic Stiffness Measurement Combined With Liver Stiffness Measurement Compared With Baveno VII Criteria in Predicting the Presence of Oesophageal and Gastric Varices in Patients With Compensated Advanced Liver Cell Disease (cALCD).
作者信息
de Silva Arjuna P, Niriella Madunil A, Nishad Nilanga, Jayasundara Hishali, Jayasena Hiruni, Samarawickrama Vajira T, Ranawaka Chamila, Basnayake Kumarini, de Silva Shamila T, de Silva Hithanadura J
机构信息
Department of Medicine, University Medical Unit, Colombo North Teaching Hospital, Faculty of Medicine, University of Kelaniya, Ragama, LKA.
Gastroenterology and Hepatology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, GBR.
出版信息
Cureus. 2024 Aug 1;16(8):e65954. doi: 10.7759/cureus.65954. eCollection 2024 Aug.
INTRODUCTION
Liver stiffness measurement (LSM) using vibration-controlled transient elastography (VCTE) is being increasingly used as a screening tool to predict varices. Our aim was to test the utility of Baveno VII criteria and other combinations of LSM, platelet count (PC), and splenic stiffness measurement (SSM) to predict the presence of varices in a cohort of Sri Lankan patients with compensated advanced liver cell disease (cALCD).
METHODS
Consecutive patients with newly diagnosed Child-Pugh class A cALCD (non-viral, BMI<30) were recruited prospectively. They underwent gastroscopy. LSM and SSM were taken using vibration-controlled transient elastography (VCTE) (Echosens FibroScan 502 Touch; Echosens SA, Paris, France) by a single operator who was unaware of endoscopy findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of different Baveno VII criteria to predict the varices and different combinations of LSM, SSM, and PC were also explored.
RESULTS
One hundred and seventy-four individuals were recruited. The mean age was 61.4 ((95% CI: 59.7-62.8) years. A total of 110 individuals were males, and 106 had varices. Our results indicated that the three Baveno VII criteria had sensitivities of 61%, 63%, and 42%, and specificities of 79%, 77%, and 87% to predict varices. SSM>30kPa alone and in combination with LSM>15kPa had sensitivities of 81 and 75%, specificities of 72 and 83%, PPVs of 82 and 87%, NPVs of 71% and 67%, and accuracies of 78 and 78%, respectively, to predict varices.
CONCLUSION
Baveno VII criteria had a low sensitivity but high specificity in predicting the presence of varices. However, SSM>30kPa alone or in combination with LSM>15kPa had better sensitivity, specificity, PPV, NPV, and accuracy in predicting varices.
引言
使用振动控制瞬时弹性成像（VCTE）进行肝脏硬度测量（LSM）越来越多地被用作预测静脉曲张的筛查工具。我们的目的是测试巴韦诺 VII 标准以及 LSM、血小板计数（PC）和脾硬度测量（SSM）的其他组合在一组斯里兰卡代偿期晚期肝细胞疾病（cALCD）患者中预测静脉曲张存在的效用。
方法
前瞻性招募新诊断为 Child-Pugh A 级 cALCD（非病毒性，BMI<30）的连续患者。他们接受了胃镜检查。由一名不知道内镜检查结果的操作员使用振动控制瞬时弹性成像（VCTE）（Echosens FibroScan 502 Touch；Echosens SA，法国巴黎）进行 LSM 和 SSM 测量。还探讨了不同巴韦诺 VII 标准预测静脉曲张的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性，以及 LSM、SSM 和 PC 的不同组合。
结果
共招募了 174 名个体。平均年龄为 61.4（（95%CI：59.7 - 62.8）岁。其中 110 名为男性，106 人有静脉曲张。我们的结果表明，三个巴韦诺 VII 标准预测静脉曲张的敏感性分别为 61%、63%和 42%，特异性分别为 79%、77%和 87%。单独的 SSM>30kPa 以及与 LSM>15kPa 联合使用时，预测静脉曲张的敏感性分别为 81%和 75%，特异性分别为 72%和 83%，PPV 分别为 82%和 87%，NPV 分别为 71%和 67%，准确性分别为 78%和 78%。
结论
巴韦诺 VII 标准在预测静脉曲张存在方面敏感性较低但特异性较高。然而，单独的 SSM>30kPa 或与 LSM>15kPa 联合使用在预测静脉曲张方面具有更好的敏感性、特异性、PPV、NPV 和准确性。
Zotero 插件