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福军亮教授：肝硬化合并高危食管静脉曲张早期诊断研究进展
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福军亮教授：肝硬化合并高危食管静脉曲张早期诊断研究进展

福军亮教授：肝硬化合并高危食管静脉曲张早期诊断研究进展 国际肝病
2025-08-20
2
导读：解放军总医院第五医学中心福军亮教授作了题为“肝硬化合并高危食管静脉曲张早期诊断研究进展”的专题报告。

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对于肝硬化合并高危食管静脉曲张（High-risk Varices, HRV）的患者，使用无创标志物进行早期诊断和干预对于降低出血事件发生率具有关键临床价值。在HRV无创筛查领域，基于常规临床参数的预测模型，如APRI、Forns index、Lok index、Fib-4、Fibro index等1-5，诊断效能欠佳，曲线下面积（Area Under the Curve, AUC）约为0.6左右3，难以满足临床需求。


多项研究表明，血小板（Platelet, PLT）和肝脏硬度值（Liver Stiffness Measurement, LSM）是HRV诊断的关键独立预测因子6-13。基于此证据基础，Baveno VI共识14提出了诊断HRV的Baveno VI标准（若患者LSM<20 kPa且PLT>150×109/L，则认为患者无HRV），但该标准的胃镜豁免率仅为25%左右15,16，临床应用受限。


近年来，脾脏硬度值（Spleen Stiffness Measurement, SSM）作为HRV诊断因子展现出良好价值17-19，Baveno VII共识提出了诊断HRV的Baveno VII标准20（若患者不符合Baveno VI标准，但符合SSM<40 kPa，仍认为患者没有HRV）。尽管Baveno VII标准显著提高胃镜豁免率，但需要依赖专用脾脏硬度测量设备，增加医疗成本及技术普及难度。


8月2日，第十一届北京肝病学术会议顺利召开。会上，解放军总医院第五医学中心福军亮教授作了题为“肝硬化合并高危食管静脉曲张早期诊断研究进展”的专题报告。报告中，福教授重点分享了其主持开展的一项全国性、多中心、大样本的临床数据研究，利用回顾性队列（n=3104）和前瞻性（n=1383）队列进行模型建立和模型验证，基于机器学习算法提出了针对HRV诊断效能更佳的诊断模型。


该项研究提出的机器学习模型，在两个队列中的AUC分别为0.948、0.898。在胃镜豁免率方面，该模型在回顾性队列（55.54% vs. 19.07%，P=0.01）和前瞻性队列（56.25% vs. 28.92%，P=0.01）中均显著优于Baveno VI标准。相较于Baveno VII标准，该机器学习模型在不增加SSM专用检查设备的情况下，实现约55%的患者豁免胃镜检查，与Baveno VII标准报道的诊断效能相似，提升了HRV筛查的经济性和可及性。


参考文献：（上下滑动查看更多）

1. Iwata Y, Enomoto H, Sakai Y, et al. Elevation of the AST to ALT ratio in association with the severity of esophageal varices in patients with HCV-related compensated liver cirrhosis. Hepatogastroenterology. 2013;60(121):149-152.

2. Tarannum S, Ilyas T, Tarannum Shaik S, et al. Assessment of the Child-Pugh Score, Model for End-Stage Liver Disease Score, Fibrosis-4 Index, and AST to Platelet Ratio Index as Non-endoscopic Predictors of the Presence of Esophageal Varices and Variceal Bleeding in Chronic Liver Disease Patients. Cureus. 2024;16(11):e73768.

3. Sebastiani G, Tempesta D, Fattovich G, et al. Prediction of oesophageal varices in hepatic cirrhosis by simple serum non-invasive markers: Results of a multicenter, large-scale study. J Hepatol. 2010;53(4):630-638.

4. Zhou H, Long J, Hu H, Tian CY, Lin SD. Liver stiffness and serum markers for excluding high-risk varices in patients who do not meet Baveno VI criteria. World J Gastroenterol. 2019;25(35):5323-5333.

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6. Pu K, Shi JH, Wang X, et al. Diagnostic accuracy of transient elastography (FibroScan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis. World J Gastroenterol. 2017;23(2):345-356.

7. Salzl P, Reiberger T, Ferlitsch M, et al. Evaluation of portal hypertension and varices by acoustic radiation force impulse imaging of the liver compared to transient elastography and AST to platelet ratio index. Ultraschall Med. 2014;35(6):528-533.

8. Procopet B, Berzigotti A, Abraldes JG, et al. Real-time shear-wave elastography: applicability, reliability and accuracy for clinically significant portal hypertension. J Hepatol. 2015;62(5):1068-1075.

9. Ronot M, Lambert S, Elkrief L, et al. Assessment of portal hypertension and high-risk oesophageal varices with liver and spleen three-dimensional multifrequency MR elastography in liver cirrhosis. Eur Radiol. 2014;24(6):1394-1402.

10. Elkrief L, Rautou PE, Ronot M, et al. Prospective comparison of spleen and liver stiffness by using shear-wave and transient elastography for detection of portal hypertension in cirrhosis. Radiology. 2015;275(2):589-598.

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12. Ding NS, Nguyen T, Iser DM, et al. Liver stiffness plus platelet count can be used to exclude high-risk oesophageal varices. Liver Int. 2016;36(2):240-245.

13. Kim MN, Kim SU, Kim BK, et al. Increased risk of hepatocellular carcinoma in chronic hepatitis B patients with transient elastography-defined subclinical cirrhosis. Hepatology. 2015;61(6):1851-1859.

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15. Qi X, Berzigotti A, Cardenas A, Sarin SK. Emerging non-invasive approaches for diagnosis and monitoring of portal hypertension. Lancet Gastroenterol Hepatol. 2018;3(10):708-719.

16. Augustin S, Pons M, Maurice JB, et al. Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease. Hepatology. 2017;66(6):1980-1988.

17. Wang H, Wen B, Chang X, et al. Baveno VI criteria and spleen stiffness measurement rule out high-risk varices in virally suppressed HBV-related cirrhosis. J Hepatol. 2021;74(3):584-592.

18. Cho YS, Kim Y, Sohn JH. Application of Supersonic Shear Imaging to the Baveno VI Criteria and a Combination Model with Spleen Stiffness Measurement to Rule Out High-Risk Varices in Compensated Advanced Chronic Liver Disease. Ultraschall Med. 2022;43(3):e13-e23.

19. Colecchia A, Ravaioli F, Marasco G, et al. A combined model based on spleen stiffness measurement and Baveno VI criteria to rule out high-risk varices in advanced chronic liver disease. J Hepatol. 2018;69(2):308-317.

20. de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C. Baveno VII - Renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959-974.


（来源：《国际肝病》编辑部）


声明：本文仅供医疗卫生专业人士了解最新医药资讯参考使用，不代表本平台观点。该信息不能以任何方式取代专业的医疗指导，也不应被视为诊疗建议，如果该信息被用于资讯以外的目的，本站及作者不承担相关责任。


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