摘要
目的探讨红细胞体积分布宽度（RDW）、红细胞体积分布宽度与血小板计数比值（RPR）、AST与血小板比值指数（APRI）、基于4因子的肝纤维化指标（FIB-4）、AST／ALT比值（AAR）对乙型肝炎肝硬化合并食管静脉曲张的评估价值。方法收集2013年12月至2015年7月天津市第三中心医院肝内科住院的乙型肝炎肝硬化且既往无胃镜下食管静脉曲张治疗史的患者190例。所有患者均行胃镜检查，若有食管静脉曲张，按静脉曲张的形态、程度及出血危险分轻、中、重3级。检测患者外周血RDW、血小板计数、ALT、AST，并计算RPR、APRI、FIB-4、AAR。相关性分析采用Spearman相关分析，用受试者工作特征（ROC）曲线及曲线下面积（AUC）判断上述指标对食管静脉曲张出血的评估价值。结果食管静脉曲张出血患者RDW、RPR、FIB-4、APRI分别为（16．78±2．27）％、0．41±0．18、8．99±5．91和2．09（1．35，2．90），明显高于未出血患者的（14．37±1．86）％（t=-7．449）、0．19±0．09（t=-8．132）、5．72±3．92（t=-3．658）和1．29（0．70，2．39；z=-2．996），差异均有统计学意义（均P〈0．05）；而AAR在两组间差异无统计学意义（t=1．216，P=0．226）。食管静脉曲张及其出血均与RDW、RPR、FIB-4、APRI呈正相关（均P〈0．05），与AAR无关（P〉0．05）。RDW（F=9．604）、RPR（F=47．530）、FIB-4（F=18．071）、APRI（H=12．320）在不同程度食管静脉曲张患者组间比较，差异均有统计学意义（均P〈0．05），而AAR在不同程度食管静脉曲张患者组间比较，差异无统计学意义（F=1．177，P=0．320）。RPR预测食管静脉曲张出血的AUC最高（0．896），其次为RDW（0．824，P〈0．05），FIB-4和APRI的AUC分别为0．690和0．642，差异无统计学意义（P〉0．05）。RDW、RPR、FIB-4、APRI的最佳诊断界值分别为14．450、0．209、6．912和1．338（P〈0．05），敏感度分别为88．24％、96．10％、66．67％和76．47％，特异度分别为64．03％、69．10％、73．38％和51．08％。结论RPR、RDW与乙型肝炎肝硬化食管静脉曲张密切相关，对食管静脉曲张出血的预测具有重要的指导意义，可作为临床筛选，且RPR优于RDW；FIB-4、APRI虽与乙型肝炎肝硬化食管静脉曲张相关，但对食管静脉曲张出血的预测价值较低。
Objective To investigate the predictive value of red cell volume distribution width （RDW）, RDW to platelet ratio （RPR）, aspartate aminotransferase （AST） to platelet ratio index （APRI）, fibrosis index based on the 4 factor （FIB 4） and aspartate-alanine aminotransferase ratio （AAR） in assessing esophageal varices （EV） in patients with hepatitis B virus （HBV）-related cirrhosis. Methods Between December 2013 and July 2015, a total of 190 patients with HBV-related cirrhosis and no previous history of endoscopic therapy for EV hospitalized at the Department of Hepatology, TianjinThird Central Hospital were enrolled. Upper gastrointestinal endoscopy were conducted in all patients to diagnose EV. According to the morphology and degree of EV as well as bleeding risk, patients were categorized into mild, moderate and severe stages. RDW, platelet counts, alanine aminotransferase, aspartate aminotransferase were tested, and RPR, APRI, FIB-4, AAR were calculated. Spearman correlation was used to evaluate the association between EV and these indexes. Receive operating characteristic （ROC） curves were generated and the areas under the curves （AUC） were calculated to assess the performance of these indexes in predicting esophageal varices bleeding （EVB）. Results RDW （[16.78±2. 271%）, RPR （0. 41±0.18）, FIB-4 （8.99±5.91）, APRI （2.09[1.35, 2.90]） in patients with EVB were all significantly higher than those （[14. 37 ±1. 861%, t= - 7. 449; 0. 19 ±0.09 [t = -8. 132]; 5.72±3.92 [t=-3. 658]; 1.29 F0.70, 2.39;z= -2. 996]） without EVB （all P〈0.05）. However, AAR had no statistical significance between two groups （t = 1. 216, P = 0. 226）. Both of EV and EVB had positive correlation with RDW, RPR, FIB-4 and APRI （all P〈0.05） and no correlation with AAR （P〉0.05）. RDW （F=9.604）, RPR （F=47.530）, FIB-4 （F=18.071） and APRI （H= 12. 320） showed statistically significant differences among patients with different stages of EV （all P〈 0.05）, whereas AAR showed no difference （F=1. 177, P=0. 320）. The AUC of RPR （0. 896） for EVB was highest, followed by RDW （0. 824,P〈0.05）. AUC of FIB-4 and APRI was 0. 690 and 0. 642, respectively, with no statistical difference （P〉0, 05）. The optimal cut-off levels of RDW, RPR, FIB-4 and APRI were 14. 450 （sensitivity： 88. 24%, specificity： 64.03%）, 0. 209 （sensitivity： 96. 10%, specificity： 69.10%）, 6. 912 （sensitivity： 66.67%, specificity： 73.38%） and 1. 338 （sensitivity： 76. 47%, specificity： 51. 08%）, respectively. Conclusions RPR and RDW are closely correlated with EV in HBV-related cirrhotic patients, which are of clinical importance in predicting EVB. Both of them can be used as clinical screening methods and RPR may be superior to RDW. Although FIB-4 and APRI are correlated with EV, their predictive value of EBV are low.
出处
《中华传染病杂志》
CAS
CSCD
北大核心
2015年第11期663-667,共5页
Chinese Journal of Infectious Diseases
基金
艾滋病和病毒性肝炎等重大传染病防治国家科技重大专项资助项目（2012ZX10002004-011）
天津市科委基金项目（13RCGFSY19200）
天津市卫生行业重点攻关项目（12KG108）
