VariScreen 确保对超出 Baveno VI 标准的乙型肝炎病毒相关肝硬化

StephenW

VariScreen 确保对超出 Baveno VI 标准的乙型肝炎病毒相关肝硬化患者的高风险静脉曲张进行筛查
谭敏 1 2 , 张无祥 1 3 , 周宏 2 , 刘玉娟 1 , 陶璐 1 , 张银 1 , 传李 1 , 杨艳艳 1 , 吴运冲 1 , 韩虎 1 , 英李 4 , 方万杨 4 ,实德林 1 5
隶属关系
隶属关系

    1
    【作者单位】： 遵义医科大学附属医院感染科;
    2
    【作者单位】： 遂宁市中心医院感染科;
    3
    【作者单位】： 遵义医科大学第三附属医院(遵义市第一人民医院)感染科;
    4
    【作者单位】： 遵义医科大学第二附属医院感染科;
    5
    【作者单位】： 遵义医科大学检验医学学院;

    PMID：36237519 PMCID：PMC9551454 DOI：10.3389/fphys.2022.1006657

抽象的

我们旨在验证血小板计数 (PLT) 与肝硬度测量 (LSM) 比值在排除 Baveno VI 标准以外的乙型肝炎病毒 (HBV) 相关代偿期肝硬化患者的高危静脉曲张 (HRV) 方面的性能。共评估了 310 名患者。评估了 PLTSM 比率 (PLER)、PLER 调整为国际标准化比率、病因、年龄和性别 (PLEASE) 和 HRV 筛查顺序算法 (VariScreen) 在排除 HRV 方面的性能，并与扩展的 Baveno VI 标准（LSM <25 kPa 和 PLT >110×109/L，EB6C）； PLT>150×109/L，模型终末期肝病评分=6（P150M6标准）； PLT >120×109/L 和白蛋白 >36 g/L（P120A36 标准）；和白蛋白-胆红素（ALBI）分级和PLT评分（ALBI-PLT评分）。在纳入的患者中，43 名 (13.9%) 患有 HRV。 PLER 预测 HRV 的受试者工作特征曲线下面积（0.771，95% 置信区间，0.720-0.817）显着高于 PLT 和 LSM（p < 0.01）。 PLER 是 HRV 的独立危险因素。 VariScreen、PLEASE 和 PLER 可以省去 20 次 (6.5%)、91 次 (29.4%) 和 60 次 (19.4%) 次内窥镜检查，分别有 0 次、3 次 (3.3%) 和 1 次 (1.7%) HRV 漏诊。 EB6C 和 P120A36 标准可以免除 45 次 (14.5%) 和 36 次 (11.6%) 内镜检查，分别漏诊 1 次 (2.2%) 和 1 次 (2.8%) HRV。 P150M6 标准和 ALBI-PLT 评分分别错过了 6.8% 和 10.3% 的 HRV。我们发现 PLER 比其他非侵入性测试表现更好。 VariScreen 确保了对超出 Baveno VI 标准的 HBV 相关肝硬化患者的 HRV 筛查。

关键词：Baveno VI 标准；肝硬化;乙型肝炎；高风险静脉曲张；肝脏硬度测量；血小板。

版权所有 © 2022 Tan, Zhang, Zhou, Liu, Lu, Zhang, Li, Yang, Wu, Hu, Li, Yang and Lin。
利益冲突声明

作者声明，该研究是在没有任何可能被解释为潜在利益冲突的商业或财务关系的情况下进行的。

StephenW

VariScreen secures the screening of high-risk varices in patients with hepatitis B virus-related cirrhosis beyond Baveno VI criteria
Min Tan  1   2 , Wuxiang Zhang  1   3 , Hong Zhou  2 , Yujuan Liu  1 , Tao Lu  1 , Yin Zhang  1 , Chuan Li  1 , Yanyan Yang  1 , Yunchong Wu  1 , Han Hu  1 , Ying Li  4 , Fangwan Yang  4 , Shide Lin  1   5
Affiliations
Affiliations

    1
    Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
    2
    Department of Infectious Diseases, Suining Central Hospital, Suining, China.
    3
    Department of Infectious Diseases, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi City), Zunyi, China.
    4
    Department of Infectious Diseases, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.
    5
    College of Laboratory Medicine, Zunyi Medical University, Zunyi, China.

    PMID: 36237519 PMCID: PMC9551454 DOI: 10.3389/fphys.2022.1006657

Abstract

We aimed to validate the performance of the ratio of the platelet count (PLT) to liver stiffness measurement (LSM) in excluding high-risk varices (HRVs) in patients with hepatitis B virus (HBV)-related compensated cirrhosis beyond Baveno VI criteria. A total of 310 patients were assessed. The performances of the PLTSM ratio (PLER), PLER adjusted for the international normalized ratio, etiology, age, and sex (PLEASE), and the sequential algorithm for HRV screening (VariScreen) in excluding HRVs were evaluated and compared with those of expanded Baveno VI criteria (LSM <25 kPa and PLT >110×109/L, EB6C); PLT >150×109/L and model for end-stage liver disease score = 6 (P150M6 criterion); PLT >120×109/L and albumin >36 g/L (P120A36 criterion); and albumin-bilirubin (ALBI) grade and PLT score (ALBI-PLT score). Among the enrolled patients, 43 (13.9%) had HRVs. The area under the receiver operating characteristic curve of PLER for predicting HRVs (0.771, 95% confidence interval, 0.720-0.817) was significantly higher than that for PLT and LSM (p < 0.01). PLER was an independent risk factor for HRVs. VariScreen, PLEASE, and PLER could spare 20 (6.5%), 91 (29.4%), and 60 (19.4%) endoscopies, with 0, 3 (3.3%), and 1 (1.7%) HRVs missed, respectively. The EB6C and P120A36 criteria could spare 45 (14.5%) and 36 (11.6%) endoscopies, with 1 (2.2%) and 1 (2.8%) HRVs missed, respectively. The P150M6 criterion and ALBI-PLT score missed 6.8% and 10.3% of HRVs, respectively. We found that PLER performed better than other non-invasive tests. VariScreen secured the screening of HRVs in patients with HBV-related cirrhosis beyond Baveno VI criteria.

Keywords: Baveno VI criteria; cirrhosis; hepatitis B; high-risk varices; liver stiffness measurement; platelets.

Copyright © 2022 Tan, Zhang, Zhou, Liu, Lu, Zhang, Li, Yang, Wu, Hu, Li, Yang and Lin.
Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

StephenW

https://www.frontiersin.org/arti ... ys.2022.1006657/pdf