Fibroscan 在预测肝硬化食管静脉曲张程度及出血中的作用 刘迎迎.docVIP

Fibroscan在预测肝硬化食管静脉曲张程度及出血中的作用 刘迎迎, 刘晓东 (漯河医学高等专科学校 医疗系，河南 漯河 462002) 【摘要】目的：为了确定能否借助瞬时弹性扫描仪(Fibroscan,FS)测定肝硬度（LS）与食管静脉曲张（EV）严重程度的相关性及预测静脉出血的发生。方法：选定100例肝硬化病人，按有无EV分成2组：组1：无或1级EV（65例），组2：2或3 级明显EV（35例）。又把其中54例EV病人分成2亚组：组Ⅰ：无出血史（37例），组Ⅱ：有出血史（17例）。通过不成对T检验对比组间LS差异，并通过使用ROC曲线确定EV和出血风险的阈值。结果：组1与组2病人相比其平均LS值明显降低。通过ROC曲线确定30 kPa为EV存在与否的LS阈值，敏感性83%，特异性62%，阳性预测值76.2%，阴性预测值71.3%。组Ⅱ（17例）的平均LS值明显高于组Ⅰ（37例）病人。51 kPa作为预测食管静脉出血发生的LS阈值，其敏感性为54.1%，特异性为83.0%，阳性预测值为81.5%，阴性预测值为55.1%。结论：通过Fibroscan测定LS值是一种检测EV和预测EV破裂出血的可靠无创方法。 【关键词】：肝硬化；瞬时弹性扫描 ；食管静脉曲张；静脉曲张破裂出血 Effect of Fibroscan for the prediction of esophageal varices and variceal bleeding LIU Ying-ying, LIU Xiao-dong. Department of Medicine Luo He Medical College HeNan Luohe 462002, China 【abstract】Objective To determine if liver stiffness (LS) measurements by means of Fibroscan (FS)correlate with the presence of significant esophageal varices (EV) and if they can predict the occurrence of variceal bleeding. Methods We studied 100 cases of liver cirrhosis divided into 2 groups: patients without EV or with grade 1 varices (65 cases) and patients with significant varices (grade 2 and 3 EV) (35 cases). We divided the group of 54 cases with EV into another 2 subgroups: without variceal hemorrhage (37 patients) and patients with a history of variceal bleeding (17 cases). We compared the LS values between the groups using the unpaired t-test and we established cut-off LS values for the presence of significant EV and for the risk of bleeding by using the ROC curve. Results The mean LS values in the group 1 was statistically significantly lower than in the group 2. Using the ROC curve we established a cut-off value of 30 kPa for the presence of EV, with 83% sensitivity and 62% specificity, with 76.2% positive predictive value (PPV) and 71.3% negative predictive value (NPV). The mean LS values in the groupⅡ(17 patients) was statistically significantly higher than in the groupⅠ(37 patients): For a cut-off value of 51 kPa, LS had 53.33% sensi