【摘要】 目的 代偿期乙型肝炎肝硬化显著门静脉高压患者发生食管胃静脉曲张（GOV）风险较大，通过评价不同无创诊断模型对GOV的诊断价值，为早期诊断GOV提供依据。方法 选取2017年11月—2023年11月广东省中医院就诊的代偿期乙型肝炎肝硬化显著门静脉高压患者108例，根据胃镜下是否伴发GOV将患者分为GOV组和非GOV组（NGOV组）。收集患者的年龄、性别、影像学、实验室指标等结果。计数资料组间比较采用χ2检验；正态分布的计量资料两组间比较采用成组t检验；非正态分布的数据两组间比较采用Mann-Whitney U检验。采用受试者操作特征曲线（ROC曲线）评估FIB-4、LOK指数、LPRI、APRI、AAR等5种评分模型的诊断价值；利用二元Logistic回归构建联合模型，将联合模型与5种评分模型单独应用时的ROC曲线下面积（AUC）比较；采用Delong检验对各无创诊断模型的AUC值进行两两比较。结果 GOV组55例，NGOV组53例。GOV组的年龄高于NGOV组[（52.64±1.44）岁vs (47.96±1.68)岁]，ALT[42.00(24.00～117.00) U/L vs 82.00(46.00～271.00) U/L]、AST[44.00(32.00～96.00) U/L vs 62.00(42.50～154.50) U/L]、PLT[100.00(69.00～120.00)×10~9/L vs 119.00(108.50～140.50)×10~9/L]低于NGOV组，差异均有统计学意义（统计值分别为3.230、-3.065、-2.351、-3.667,P值均<0.05）。ROC曲线分析显示，FIB-4、LOK指数、LPRI、AAR单独诊断GOV的AUC分别为0.667、0.681、0.730、0.639(P值均<0.05),GOV阳性诊断率分别为69.97%、65.28%、67.33%、58.86%,AUC值比较差异均无统计学意义（P值均>0.05）,APRI单独应用无诊断价值（P>0.05）。利用二元Logistic回归构建联合模型LAF,AUC为0.805,GOV阳性诊断率为75.80%，明显高于FIB-4、LOK指数、LPRI、AAR单独应用时的AUC值（Z值分别为-2.773、-2.479、-2.206、-2.672,P值均<0.05）。结论 FIB-4、LOK指数、LPRI、AAR对代偿期乙型肝炎肝硬化显著门静脉高压患者发生GOV诊断价值相似，APRI单独应用无诊断价值，联合模型LAF的诊断效能最佳，对临床推广和应用具有一定参考价值。更多还原

【Abstract】 Objective To investigate the value of different noninvasive diagnostic models in the diagnosis of esophageal and gastric varices since there is a high risk of esophageal and gastric varices in patients with compensated hepatitis B cirrhosis and significant portal hypertension, and to provide a basis for the early diagnosis of esophageal and gastric varices. Methods A total of 108 patients with significant portal hypertension due to compensated hepatitis B cirrhosis who attended Guangdong Provincial Hospital of Traditional Chinese Medicine from November 2017 to November 2023 were enrolled, and according to the presence or absence of esophageal and gastric varices under gastroscopy, they were divided into esophageal and gastric varices group(GOV group) and non-esophageal and gastric varices group(NGOV group). Related data were collected, including age, sex, imaging findings, and laboratory markers. The chi-square test was used for comparison of categorical data between groups; the least significant difference t-test was used for comparison of normally distributed continuous data between groups, and the MannWhitney U test was used for comparison of non-normally distributed continuous data between groups. The receiver operating characteristic(ROC) curve was plotted to evaluate the diagnostic value of five scoring models, i.e., fibrosis-4(FIB-4), LOK index, LPRI, aspartate aminotransferase-to-platelet ratio index(APRI), and aspartate aminotransferase/alanine aminotransferase ratio(AAR). The binary logistic regression method was used to establish a combined model, and the area under the ROC curve(AUC) was compared between the combined model and each scoring model used alone. The Delong test was used to compare the AUC value between any two noninvasive diagnostic models. Results There were 55 patients in the GOV group and 53 patients in the NGOV group. Compared with the NGOV group, the GOV group had a significantly higher age(52.64±1.44 years vs 47.96±1.68 years, t=0.453, P<0.05) and significantly lower levels of alanine aminotransferase [42.00(24.00 — 17.00) U/L vs 82.00(46.00 — 271.00) U/L, Z=-3.065, P<0.05], aspartate aminotransferase [44.00(32.00 — 96.00) U/L vs 62.00(42.50 — 154.50) U/L,Z=-2.351, P<0.05], and platelet count [100.00(69.00 — 120.00)×10~9/L vs 119.00(108.50 — 140.50)×10~9/L, Z=-3.667, P<0.05]. The ROC curve analysis showed that FIB-4, LOK index, LPRI, and AAR used alone had an accuracy of 0.667, 0.681, 0.730, and 0.639, respectively, in the diagnosis of esophageal and gastric varices(all P<0.05), and the positive diagnostic rates of GOV were 69.97%, 65.28%, 67.33%, and 58.86%, respectively, with no significant differences in AUC values(all P>0.05), while APRI used alone had no diagnostic value(P>0.05). A combined model(LAF) was established based on the binary logistic regression analysis and had an AUC of 0.805 and a positive diagnostic rate of GOV of 75.80%, with a significantly higher AUC than FIB-4, LOK index, LPRI, and AAR used alone(Z=-2.773,-2.479,-2.206, and-2.672, all P<0.05). Conclusion FIB-4, LOK index, LPRI, and AAR have a similar diagnostic value for esophageal and gastric varices in patients with compensated hepatitis B cirrhosis and significant portal hypertension, and APRI alone has no diagnostic value. The combined model LAF had the best diagnostic efficacy, which provides a certain reference for clinical promotion and application.更多还原