背景:使用振动控制的瞬时弹性成像(VCTE)的肝脏硬度测量(LSM)正越来越多地用作预测静脉曲张的筛查工具。我们的目的是测试BavenoVII标准和其他LSM组合的实用性,血小板计数(PC),和脾硬度测量(SSM),以预测一组斯里兰卡代偿期晚期肝细胞疾病(cALCD)患者中静脉曲张的存在。
方法:新诊断的Child-PughA级cALCD(非病毒,BMI<30)是前瞻性招募的。他们接受了胃镜检查。LSM和SSM采用振动控制的瞬时弹性成像(VCTE)(EchosensFibroScan502Touch;EchosensSA,巴黎,法国)由一位不知道内窥镜检查结果的操作员提供。灵敏度,特异性,阳性预测值(PPV),负预测值(NPV),以及不同BavenoVII标准预测静脉曲张和不同组合的LSM的准确性,SSM,和PC也被探索。
结果:招募了一百七十四个人。平均年龄为61.4((95%CI:59.7-62.8)岁。共有110个人是男性,106有静脉曲张。我们的结果表明,三个BavenoVII标准的敏感性为61%,63%,42%,79%的特异性,77%,87%预测静脉曲张。单独使用SSM>30kPa和LSM>15kPa的敏感性为81%和75%,72%和83%的特异性,PPV为82%和87%,NPV分别为71%和67%,准确率为78%和78%,分别,预测静脉曲张。
结论:BavenoVII标准在预测静脉曲张存在时敏感性低,但特异性高。然而,SSM>30kPa单独或与LSM>15kPa组合具有更好的灵敏度,特异性,PPV,NPV,预测静脉曲张的准确性。
BACKGROUND: 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.
CONCLUSIONS: 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.