基于血小板计数和白蛋白联合模型排除肝硬化高危静脉曲张

StephenW

Validation of the Combined Model Based on Platelet Count and Albumin to Rule out High-Risk Varices in Liver Cirrhosis
Zhihui Duan  1 , Li Li  2 , Jinlong Li  3 , Shengyun Zhou  1
Affiliations
Affiliations

    1
    Department of Endoscopy, Xingtai People's Hospital, Xingtai, 054000 Hebei Province, China.
    2
    Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
    3
    Clinical Laboratory, Xingtai People's Hospital, Xingtai, 054000 Hebei Province, China.

    PMID: 32766309 PMCID: PMC7374218 DOI: 10.1155/2020/5783748

Free PMC article
Abstract

Background: The Baveno VI criteria based on platelet count and liver stiffness, measured by transient elastography (TE), have been proposed to rule out high-risk varices (HRV) defined as medium or large-sized varices or the presence of high-risk stigmata (cherry red spots and red wale marks). However, TE is not available in all hospitals. Recently, the Rete Sicilia Selezione Terapia hepatitis C virus (RESIST-HCV) criteria recommended that cirrhotic patients with a platelet count > 120000/μL and serum albumin > 36 g/L could avoid esophagogastroduodenoscopy (EGD) screening for HRV.

Aim: We aimed to validate the performance of the RESIST-HCV criteria in two cohorts predominantly characterized with hepatitis B infection.

Methods: Patients with compensated cirrhosis who had blood tests within three months of performing EGD and TE were enrolled retrospectively from two centers. RESIST-HCV criteria were applied to identify patients who did not require EGD screening.

Results: This study included 188 patients from the Xingtai cohort (28 (14.9%) with HRV) and 104 patients from the Beijing cohort (19 (18.3%) with HRV). Of the patients who met the RESIST-HCV criteria (83 in the Xingtai cohort and 26 in the Beijing cohort), 0 and 1 had HRV, respectively, accounting for 44.1% (Xingtai cohort) and 25% (Beijing cohort) of endoscopies that were unnecessary. In the combined cohort, 109 (37.3%) patients met the RESIST-HCV criteria, only 1 (0.9%) HRV was missed, and the negative predictive value was 99.1%. Baveno VI and Expanded Baveno VI criteria spared 15.6% and 23.3% of EGDs, respectively, while missing 0% and 4.8% of HRV, respectively.

Conclusions: In our population, the combined criteria based on platelet count and serum albumin performed well, saving 30-40% of EGDs and correctly identifying 99.1% of patients who could safely avoid screening endoscopies for high-risk varices in compensated cirrhotic patients.

Copyright © 2020 Zhihui Duan et al.

StephenW

基于血小板计数和白蛋白联合模型排除肝硬化高危静脉曲张的验证
段志辉1，李丽2，金龙丽3，周生云1
隶属关系
隶属关系

    1个
    邢台市人民医院内镜科，河北邢台054000
    2
    首都医科大学附属北京世纪坛医院消化内科，北京100038
    3
    邢台市人民医院临床实验室，河北邢台054000

    PMID：32766309 PMCID：PMC7374218 DOI：10.1155 / 2020/5783748

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抽象

背景：已经提出了基于血小板计数和肝硬度的Baveno VI标准（通过瞬时弹性成像（TE）进行测量）来排除高风险静脉曲张（HRV），HRV被定义为中型或大型静脉曲张或存在高风险柱头（樱桃红色斑点和红色鲸鱼纹）。但是，并非所有医院都提供TE。最近，Rec Sicilia Selezione Terapia丙型肝炎病毒（RESIST-HCV）标准建议，血小板计数> 120000 /μL，血清白蛋白> 36 g / L的肝硬化患者可以避免进行食管胃十二指肠镜（EGD）筛查HRV。

目的：我们旨在验证以乙型肝炎感染为主要特征的两个队列中RESIST-HCV标准的效果。

方法：从两个中心回顾性研究了在进行EGD和TE的三个月内进行血液检查的代偿性肝硬化患者。 RESIST-HCV标准用于鉴定不需要EGD筛查的患者。

结果：本研究纳入了邢台队列中的188例患者（28例（14.9％）HRV）和北京队列中104例（19例（18.3％）HRV）。符合RESIST-HCV标准的患者（邢台队列83例，北京队列26例）中，有0例和1例HRV，分别占内镜检查的44.1％（邢台队列）和25％（北京队列）。没必要。在合并的队列中，有109名（37.3％）患者符合RESIST-HCV标准，仅漏诊了1名（0.9％）HRV，阴性预测值为99.1％。 Baveno VI和扩展的Baveno VI标准分别节省了EGD的15.6％和23.3％，而分别缺少HRV的0％和4.8％。

结论：在我们的人群中，基于血小板计数和血清白蛋白的综合标准效果良好，可节省30-40％的EGD，并正确识别99.1％的患者，这些患者可以安全地避免对代偿性肝硬化患者进行内镜检查以筛查高风险静脉曲张。

版权所有©2020 Zhihui Duan等。

StephenW

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