抗病毒治疗筛查HBV相关性肝硬化患者的静脉曲张：单独使用

StephenW

Screening varices in patients with HBV-related cirrhosis on antiviral therapy: Platelet alone or together with LSM
Bingqiong Wang  1 , Jialing Zhou  1 , Xiaoning Wu  1 , Yameng Sun  1 , Lei Li  2 , Ping Li  3 , Minghui Li  4 , Wei Jiang  5 , Mingyi Xu  6 , Bo Feng  7 , Xiaoyuan Xu  8 , Jilin Cheng  9 , Wen Xie  4 , Tao Han  10 , Xiaozhong Wang  11 , Hai Li  12 , Hongxin Piao  13 , Shanshan Wu  1 , Yiwen Shi  1 , Shuyan Chen  1 , Yuanyuan Kong  1 , Hong Ma  1 , Xiaojuan Ou  1 , Jidong Jia  1 , Hong You  1
Affiliations
Affiliations

    1
    Liver Research Center, Beijing Friendship Hospital, Capital Medical University, BeijingKey Laboratory of Translational Medicine on Liver Cirrhosis, National Clinical Research Center for Digestive Diseases, Beijing, China.
    2
    Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China.
    3
    Department of Hepatology, Tianjin Second People's Hospital, Tianjin, China.
    4
    Liver Disease Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
    5
    Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China.
    6
    Department of Gastroenterology and Hepatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
    7
    Hepatology Institute, Peking University People's Hospital, Beijing, China.
    8
    Department of Infectious Disease, Peking University First Hospital, Beijing, China.
    9
    Department of Gastroenterology, Shanghai Public Health Clinical Center, Shanghai, China.
    10
    Department of Hepatology, Tianjin Third Central Hospital, Tianjin Medical University, Tianjin, China.
    11
    Department of Hepatology, Xinjiang Uygur Autonomous Region Traditional Chinese Medicine Hospital, Urumqi, Xinjiang, China.
    12
    Department of Gastroenterology, Tianjin Xiqing Hospital, Tianjin, China.
    13
    Department of Infectious Diseases, Affiliated Hospital of Yanbian University, Yanji, China.

    PMID: 33277803 DOI: 10.1111/liv.14752

Abstract

Background & aims: Non-invasive assessment criteria to rule out high-risk varices (HRV) in compensated hepatitis B virus (HBV) cirrhosis on antiviral therapy remains unclear.

Methods: HBV-related compensated cirrhotic patients underwent screening endoscopy during antiviral therapy were enrolled and randomly divided into the derivation and validation sets. HRV were defined as medium to large varices or small varices with red signs. Univariate and multivariate logistic analysis were used to determine the parameters associated with HRV.

Results: A total of 436 HBV-related compensated cirrhotic patients screened for varices were enrolled, the median duration of antiviral therapy was 4 years (IQR: 2.5-5.5 years). In the derivation set (N = 290, 17.2% with HRV), only platelet (PLT) count (OR = 0.972, 95% CI 0.961-0.984, P <0.05) was independently associated with HRV, whereas liver stiffness measurement was not associated with the presence of HRV. With a PLT count cut-off value of 105 x109 /L, unnecessary endoscopies could be spared in 56.9% patients, with a 3.6%. risk of missing HRV. In the validation cohort (N = 146, 16.4% with HRV), the proportion of patients that could safely spare endoscopies (61.0%) identified by this PLT count cut-off value was higher than that obtained by using Baveno VI criteria (34.9%), with an acceptable risk of missing HRV (3.4%).

Conclusion: Compared with the "Baveno VI criteria or beyond" criteria, PLT count higher than 105 x109 /L could safely spare more screening endoscopies without increasing the risk of missing HRV in patients with HBV-related compensated cirrhosis on antiviral therapy.

Keywords: Baveno VI; Hepatitis B virus; High-risk varices; Platelets.

StephenW

抗病毒治疗筛查HBV相关性肝硬化患者的静脉曲张：单独使用血小板或与LSM一起使用
王炳琼1，周嘉玲1，吴晓宁1，孙亚萌1，李磊2，李萍3，明慧丽4，姜伟5，徐明义6，博峰7，徐小元8，吉林成9，谢文4，陶汉10，王晓忠11，海莉12，红新票13，吴珊珊1，石一文1，陈书彦1，圆圆孔1，洪马1，欧小娟1，冀东甲1，洪佑1
隶属关系
隶属关系

    1个
    首都医科大学附属北京友谊医院肝脏研究中心，北京市肝硬化转化医学重点实验室，国家消化系统疾病临床研究中心，中国北京。
    2
    首都医科大学附属北京佑安医院消化内科，北京
    3
    天津市第二人民医院肝科，天津。
    4
    首都医科大学附属北京地坛医院肝病中心，北京
    5
    复旦大学附属中山医院消化内科，上海
    6
    上海交通大学医学院附属上海总医院消化内科，上海
    7
    北京大学人民医院肝病研究所，北京
    8
    北京大学第一医院感染科，北京。
    9
    上海市公共卫生临床中心消化内科，上海
    10
    天津医科大学附属天津市第三中心医院肝科，天津
    11
    新疆维吾尔自治区中医医院肝病科，新疆乌鲁木齐
    12
    天津市西青医院消化内科，天津
    13
    延边大学附属医院传染病科，延吉

    PMID：33277803 DOI：10.1111 / liv.14752

抽象

背景与目的：尚无明确评估抗病毒治疗以补偿代偿性乙型肝炎病毒（HBV）肝硬化的高风险静脉曲张（HRV）的非侵入性评估标准。

方法：纳入抗病毒治疗期间接受内镜检查的HBV相关代偿性肝硬化患者，并将其随机分为派生和验证集。 HRV被定义为具有红色体征的中大型静脉曲张或小型静脉曲张。单因素和多因素逻辑分析用于确定与HRV相关的参数。

结果：共纳入436例经静脉曲张筛查的HBV相关代偿性肝硬化患者，平均抗病毒治疗时间为4年（IQR：2.5-5.5年）。在派生组中（N = 290，HRV为17.2％），只有血小板（PLT）计数（OR = 0.972，95％CI 0.961-0.984，P <0.05）与HRV独立相关，而肝硬度测量则不相关HRV的存在。 PLT计数的临界值为105 x109 /L，56.9%的患者（3.6％）可以避免不必要的内镜检查。缺少HRV的风险。在验证队列中（N = 146，HRV为16.4％），通过该PLT计数截止值确定的可以安全地接受内镜检查的患者比例（61.0％）高于使用Baveno VI标准获得的比例（34.9％） ），且有接受HRV遗漏的风险（3.4％）。

结论：与“ Baveno VI标准或更高标准”相比，PLT计数高于105 x109 / L可以安全地保留更多筛查内镜检查，而不会增加抗病毒治疗的HBV相关性肝硬化患者HRV漏诊的风险。

关键字：Baveno VI；乙型肝炎病毒;高风险静脉曲张；血小板。