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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2022, Vol. 11 ›› Issue (03) : 263 -267. doi: 10.3877/cma.j.issn.2095-3232.2022.03.010

临床研究

MRI测量脾长径联合FIB-4对肝硬化高风险食管静脉曲张的预测价值
朱婕1, 李明凯2, 李梦思1, 伊卓雅1, 肖远强1, 王劲1,†()   
  1. 1. 510630　广州，中山大学附属第三医院放射科
    2. 510630　广州，中山大学附属第三医院消化内科
  • 收稿日期:2022-03-01 出版日期:2022-06-10
  • 通信作者: 王劲
  • 基金资助:
    国家自然科学基金重大研究计划培育项目(91959118)

Predictive value of maximum spleen diameter measured by MRI combined with FIB-4 index for high-risk esophageal varices in patients with liver cirrhosis

Jie Zhu1, Mingkai Li2, Mengsi Li1, Zhuoya Yi1, Yuanqiang Xiao1, Jin Wang1()   

  1. 1. Department of Radiology, the Third Affiliated Hospital ofSun Yat-sen University, Guangzhou 510630, China
    2. Department of Gastroenterology, the Third Affiliated Hospital ofSun Yat-sen University, Guangzhou 510630, China
  • Received:2022-03-01 Published:2022-06-10
  • Corresponding author: Jin Wang
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引用本文：

朱婕, 李明凯, 李梦思, 伊卓雅, 肖远强, 王劲. MRI测量脾长径联合FIB-4对肝硬化高风险食管静脉曲张的预测价值[J]. 中华肝脏外科手术学电子杂志, 2022, 11(03): 263-267.

Jie Zhu, Mingkai Li, Mengsi Li, Zhuoya Yi, Yuanqiang Xiao, Jin Wang. Predictive value of maximum spleen diameter measured by MRI combined with FIB-4 index for high-risk esophageal varices in patients with liver cirrhosis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2022, 11(03): 263-267.

目的

探讨MRI测量的脾长径联合纤维化-4（FIB-4）指数对肝硬化患者高风险食管静脉曲张（HREV）的预测价值。

方法

回顾性分析2018年7月至2021年1月在中山大学附属第三医院接受胃镜和MRI检查的80例肝硬化患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男62例，女18例；平均年龄（50±11）岁。根据胃镜结果确定HREV。采用Logistic回归分析HREV的独立预测因子，并推导出HREV的预测模型SF评分。确定HREV截断值后，采用Delong检验比较SF评分、血小板计数与脾长径比值（PSR）及FIB-4指数诊断HREV的ROC曲线下面积。

结果

胃镜发现HREV患者50例。Logistic回归分析显示脾长径及FIB-4指数是HREV的独立预测因子（OR=1.561，1.285；P<0.05）。预测公式：SF=0.251×（FIB-4）+0.51×[脾脏长径（cm）]。SF评分、PSR及FIB-4指数诊断HREV的ROC曲线下面积分别为0.899、0.837、0.763，Delong检验显示SF评分对HREV的诊断性能明显高于PSR（Z=2.145，P<0.05）和FIB-4指数（Z=3.006，P<0.05）。SF评分截断值为6.75分时，敏感度为0.96，特异度0.73，阳性似然比3.60，阴性似然比0.05。SF评分截断值为8.16分时，敏感度为0.70，特异度0.93，阳性似然比10.50，阴性似然比0.30。

结论

MRI测量的脾长径联合FIB-4指数构建的SF评分是有效预测肝硬化HREV的无创方法。

关键词: 肝硬化, 食管静脉曲张, 磁共振成像, FIB-4, 预测
Objective

To assess the predictive value of maximum spleen diameter measured by MRI combined with fibrosis-4 (FIB-4) index for high-risk esophageal varices (HREV) in patients with liver cirrhosis.

Methods

Clinical data of 80 patients with liver cirrhosis who received gastroscopy and MRI examination in the Third Affiliated Hospital of Sun Yat-sen University from July 2018 to January 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 62 patients were male and 18 female, aged (50±11) years on average. HREV was diagnosed according to the results of gastroscopy. Independent predictive factors of HREV were identified by Logistic regression analysis. The SF score of HREV prediction model was calculated. After determining the cut-off value of HREV, the area under ROC curve of SF score, platelet count to spleen diameter ratio (PSR) and FIB-4 index in the diagnosis of HREV was compared with Delong test.

Results

50 patients were diagnosed with HREV by gastroscopy. Logistic regression analysis revealed that maximum spleen diameter and FIB-4 index were the independent predictive factors for HREV (OR=1.561, 1.285; P<0.05). Prediction formula: SF=0.251×(FIB-4)+0.51×[maximum spleen diameter (cm)]. The area under ROC curve of SF score, PSR and FIB-4 index in diagnosing HREV was 0.899, 0.837 and 0.763, respectively. Delong test revealed that the diagnostic efficiency of SF score was significantly higher than those of PSR (Z=2.145, P<0.05) and FIB-4 index (Z=3.006, P<0.05). When the cut-off value of SF score was 6.75, the sensitivity was calculated as 0.96, the specificity was 0.73, the positive likelihood ratio was 3.60, and the negative likelihood ratio was 0.05. When the cut-off value of SF score was 8.16, the sensitivity was 0.70, 0.93 for the specificity, 10.50 for the positive likelihood ratio and 0.30 for the negative likelihood ratio.

Conclusions

SF score of maximum spleen diameter measured by MRI combined with FIB-4 index is an effective non-invasive approach to predict HREV in patients with liver cirrhosis.

Key words: Liver cirrhosis, Esophageal varices, Magnetic resonance imaging, FIB-4, Forecasting
表1 HREV与非HREV肝硬化患者一般资料比较
指标 HREV组 非HREV组
年龄（岁，±s） 50±11 53±12
男/女（例） 40/10 22/8
病因（例）    
  HBV 39 21
  HCV 02 02
  ALD 06 03
  其他 03 04
Child-Pugh分级（例）    
  A级 17 21
  B级 18 09
  C级 15 00
AST[U/L，M（QR）] 47（32） 44（35）
ALT[U/L，M（QR）] 39（34） 39（37）
TB[μmol/L，M（QR）] 35（53） 22（18）
ALB[g/L，M（QR）]） 35（6）0 39（6）0
Scr[μmol/L，M（QR）] 72（27） 83（26）
Plt[×109/L，M（QR）] 72（27） 116（67）0
PT[s，M（QR）] 17（5）0 15（3）0
INR[M（QR）] 1.4（0.4） 1.2（0.2）
脾长径[cm，M（QR）] 13.8（3.0）0 10.6（1.8）0
FIB-4[分，M（QR）]） 6.0（4.5） 3.4（3.9）
PSR[（n/mm3）/mm，M（QR）] 518（392） 1 018（796）0.
表2 肝硬化HREV预测因素的Logistic回归分析
变量 单因素分析 多因素分析
OR(95%CI) P值 OR(95%CI) P值
脾长径 1.314(1.296，2.266) <0.001 1.561(1.162，2.098) 0.003
Plt 0.977(0.964，0.989) <0.001 - -
INR 11.758(1.657，83.418) <0.014 - -
PT 1.243(1.035，1.493) <0.020 - -
ALB 0.852(0.765，0.948) <0.003 - -
FIB-4 1.348(1.118，1.625) <0.002 1.285(1.055，1.566) 0.013
图1 HREV不同预测模型ROC曲线注：HREV为高风险食管静脉曲张，PSR为血小板计数与脾长径比值，FIB-4为纤维化-4，SF为脾长径与FIB-4联合评分，Reference Line为参考线
表3 无创模型对肝硬化HREV的预测性能
模型 曲线下面积 Z值 P值 截断值 敏感度 特异度 阳性预测值 阴性预测值 阳性似然比 阴性似然比
SF 0.899 - - 6.75 0.96 0.73 0.86 0.92 3.60 0.05
8.16 0.70 0.93 0.95 0.65 10.50 0.30
PSR 0.837 2.145a 0.033 a 801 0.96 0.40 0.73 0.86 1.60 0.10
909 0.86 0.67 0.81 0.74 2.50 0.20
FIB-4 0.763 3.006 a 0.003 a 1.38 0.98 0.20 0.67 0.86 1.20 0.10
3.04 0.90 0.50 0.75 0.75 1.80 0.20
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