Department of Gastroenterology, The Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, No.57 Canghou Street, Wenzhou, Zhejiang, 325000, China.
Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
J Cardiothorac Surg. 2024 Sep 18;19(1):532. doi: 10.1186/s13019-024-03047-5.
The objective of this study is to evaluate the diagnostic accuracy of noninvasive serum liver fibrosis markers and portal vein diameter (PVD) in predicting the occurrence of esophageal variceal bleeding (EVB) in patients with cirrhosis.
A cohort comprising 102 individuals diagnosed with cirrhosis was divided into two groups: the P group (without EVB) and the PE group (with EVB). We conducted a comprehensive analysis comparing various noninvasive serum liver fibrosis indices, the Child-Pugh classification, ratios of aspartate aminotransferase to alanine aminotransferase, aspartate aminotransferase to platelet ratio index, fibrosis index based on four factors (FIB-4), PVD, and spleen thickness (SPT) between these groups. Receiver operating characteristic (ROC) curves were constructed for variables showing significant differences between the two groups, with subsequent calculation of the area under the ROC curve (AUROC) for each variable.
Significant distinctions were noted in the serum liver fibrosis markers between the P and PE groups, encompassing hyaluronic acid (HA), type III procollagen (PC-III), type IV collagen (IV-C), PVD, SPT, and FIB-4 (p < 0.05), as evidenced by univariate analysis findings. The respective AUROC values for these markers were 0.653, 0.706, 0.710, 0.730, 0.660, and 0.633. Additionally, upon integration with PVD, SPT, and FIB4, the AUROC values for liver fibrosis markers surged to 0.793, 0.763, and 0.706 correspondingly, highlighting the enhanced diagnostic potential.
The integration of noninvasive liver fibrosis indices and PVD showcased remarkable diagnostic potential in EVB, underscoring its clinical relevance in predicting hemorrhagic events.
本研究旨在评估无创性血清肝纤维化标志物和门静脉直径（PVD）在预测肝硬化患者食管静脉曲张出血（EVB）发生中的诊断准确性。
本队列研究纳入了 102 名被诊断为肝硬化的患者，分为 P 组（无 EVB）和 PE 组（有 EVB）。我们对两组间的各种无创性血清肝纤维化指标、Child-Pugh 分级、天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值、天门冬氨酸氨基转移酶/血小板比值指数、基于四项指标的纤维化指数（FIB-4）、PVD 和脾厚（SPT）进行了全面分析。对两组间有显著差异的变量绘制了受试者工作特征（ROC）曲线，并计算了每个变量的 ROC 曲线下面积（AUROC）。
单因素分析显示，P 和 PE 两组间的血清肝纤维化标志物存在显著差异，包括透明质酸（HA）、III 型前胶原（PC-III）、IV 型胶原（IV-C）、PVD、SPT 和 FIB-4（p<0.05）。这些标志物的 AUROC 值分别为 0.653、0.706、0.710、0.730、0.660 和 0.633。此外，将 PVD、SPT 和 FIB4 与肝纤维化标志物相结合后，其 AUROC 值分别提高至 0.793、0.763 和 0.706，显示出增强的诊断潜力。
无创性肝纤维化指标与 PVD 的结合在 EVB 中具有显著的诊断潜力，突出了其在预测出血事件中的临床意义。
