Abassa Kodjo Kunale, Guo Xiaoning, Tan Shuyan, Liang Zhiling, Tan Siwei
Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Biomark Insights. 2025 May 16;20:11772719251339185. doi: 10.1177/11772719251339185. eCollection 2025.
Noninvasive and cost-effective markers are needed to replace esophagogastroduodenoscopy in the screening for severe esophagogastric varices (EGVs) and portal hypertensive gastropathy (PHG).
This study evaluated the performances of several commonly used fibrosis markers in assessing EGVs and PHG in cirrhosis patients.
Retrospective cohort study.
A series of 323 patients with cirrhosis were consecutively enrolled and endoscopically followed up until variceal eradication was achieved. The Fibrosis-4 (FIB-4) score, albumin-bilirubin (ALBI) index, aspartate aminotransferase (AST)-to-alanine aminotransferase (ALT) ratio (AAR), AST-to-platelet ratio index (APRI), gamma-glutamyl transpeptidase-to-platelet ratio (GPR), and Lok score were calculated for each patient upon first admission. The performances of these markers in assessing EGVs and PHG were determined.
In the screening for clinically relevant esophageal varices (CREVs), none of the markers showed a significant ability to differentiate CREVs from non-CREVs ( > .05). The AAR (area under the curve (AUC): 0.581, sensitivity: 52.0%, specificity: 66.1%, = .033) and the GPR (AUC = 0.596, sensitivity: 64.0%, specificity: 50.0%, = .033) fairly differentiated clinically relevant gastric varices (CRGVs) from non-CRGVs patients. Moreover, no correlation was noted between PHG and CREVs ( = .016, .778) or between PHG and CRGVs ( = -.024, = .666). Furthermore, no difference in the severity of PHG before and after variceal eradication was detected ( = .224).
The studied markers revealed poor to no ability to assess EGVs or PHG. Hence, they cannot be used to substitute EGD in the screening for EGVs. Furthermore, endoscopic eradication of EGVs did not affect the severity of PHG.
在筛查严重食管胃静脉曲张（EGV）和门静脉高压性胃病（PHG）时，需要非侵入性且经济高效的标志物来替代食管胃十二指肠镜检查。
本研究评估了几种常用纤维化标志物在评估肝硬化患者EGV和PHG方面的性能。
回顾性队列研究。
连续纳入323例肝硬化患者，并进行内镜随访直至静脉曲张消除。首次入院时为每位患者计算纤维化-4（FIB-4）评分、白蛋白-胆红素（ALBI）指数、天冬氨酸转氨酶（AST）与丙氨酸转氨酶（ALT）比值（AAR）、AST与血小板比值指数（APRI）、γ-谷氨酰转肽酶与血小板比值（GPR）以及Lok评分。确定这些标志物在评估EGV和PHG方面的性能。
在筛查临床相关食管静脉曲张（CREV）时，没有一种标志物显示出将CREV与非CREV区分开来的显著能力（>0.05）。AAR（曲线下面积（AUC）：0.581，敏感性：52.0%，特异性：66.1%，P = 0.033）和GPR（AUC = 0.596，敏感性：64.0%，特异性：50.0%，P = 0.033）能较好地区分临床相关胃静脉曲张（CRGV）患者与非CRGV患者。此外，未发现PHG与CREV之间存在相关性（P = 0.016，r = 0.778），也未发现PHG与CRGV之间存在相关性（P = -0.024，r = 0.666）。此外，未检测到静脉曲张消除前后PHG严重程度的差异（P = 0.224）。
所研究的标志物在评估EGV或PHG方面显示出较差或无评估能力。因此，它们不能用于替代食管胃十二指肠镜检查来筛查EGV。此外，内镜下消除EGV并未影响PHG的严重程度。
