RESIST-HCV标准预测代偿期肝硬化患者食管胃静脉曲张出血风险的价值
| 作 者：白亚旭, 孙天佑, 刘亚冰, 吉晓林, 齐正, 韩翠平, 马玉荣, 陈树波, 段志辉, 李辉 |
| 单 位：邢台市人民医院 |
| 基金项目：邢台市科技计划项目 |
| 摘 要： |
| 背景：Baveno Ⅵ标准可识别食管胃静脉曲张出血风险较低的肝硬化患者，但其在临床实践中存在一定局限性。基于血小板计数（PLT）和血清白蛋白（Alb）浓度的RESIST-HCV标准已被证实可准确识别低出血风险静脉曲张患者，但在中国人群中尚缺乏临床验证。目的：评估RESIST-HCV标准对我国代偿期肝硬化患者食管胃静脉曲张出血风险的预测价值。方法：纳入2020年1月—2024年12月邢台市人民医院确诊为代偿期肝硬化的患者289例，收集患者的临床资料、实验室指标、内镜检查结果和肝脏硬度值（LSM）。根据内镜下判断的静脉曲张出血风险，将患者分为高出血风险静脉曲张（HRV）组和非HRV组。计算RESIST-HCV标准、Baveno Ⅵ标准、扩展Baveno Ⅵ标准预测非HRV的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。结果：与非HRV患者相比，HRV患者体质指数、凝血酶原时间、国际标准化比值显著升高（P均<0.05），PLT显著降低（P<0.05）。根据RESIST-HCV标准，97例（33.6%）患者为非HRV，预测敏感性为92.7%，特异性为39.7%，PPV为26.6%，NPV为95.9%，HRV漏诊率为4.1%。180例患者完成肝脏瞬时弹性成像检查，根据Baveno Ⅵ标准，28例（15.6%）患者为非HRV，预测敏感性为96.2%，特异性为17.5%，PPV为16.4%，NPV为96.4%，HRV漏诊率为3.6%；根据扩展Baveno Ⅵ标准，68例（37.8%）患者为非HRV，预测敏感性为92.3%，特异性为42.9%，PPV为21.4%，NPV为97.1%，HRV漏诊率为2.9%。结论：RESIST-HCV标准可使约30%的代偿期肝硬化患者避免胃镜检查，对低出血风险静脉曲张具有一定的筛查价值。 |
| 关键词：肝硬化；食管和胃静脉曲张；血小板计数；白蛋白类；肝脏硬度值 |
Value of the RESIST-HCV Criteria in Predicting Risk of Esophagogastric Variceal Bleeding in Patients With Compensated Cirrhosis
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| Abstract: |
| Background: The Baveno Ⅵ criteria can be used to identify cirrhotic patients at low risk of esophagogastric variceal bleeding, but it has certain limitations in clinical practice. The RESIST-HCV criteria, based on platelet count (PLT) and serum albumin (Alb) concentration, has been validated to accurately identify patients at low risk of variceal bleeding. However, its performance has not been verified in Chinese population. Aims: To assess the value of the RESIST-HCV criteria in predicting risk of esophagogastric variceal bleeding in Chinese patients with compensated cirrhosis. Methods: A total of 289 patients diagnosed with compensated cirrhosis at the Xingtai People's Hospital from January 2020 to December 2024 were enrolled. Clinical data, laboratory parameters, endoscopic findings, and results of liver stiffness measurement (LSM) were collected. Patients were divided into high-risk varices (HRV) group and non-HRV group according to the risk of variceal bleeding endoscopically. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the RESIST-HCV, Baveno Ⅵ, and expanded Baveno Ⅵ criteria for predicting low risk of variceal bleeding were calculated and compared. Results: Compared to non-HRV patients, patients with HRV showed significantly higher body mass index, prothrombin time, and international normalized ratio (all P<0.05), and significantly lower PLT (P<0.05). According to the RESIST-HCV criteria, 97 (33.6%) patients were classified as non-HRV, with a sensitivity of 92.7%, specificity of 39.7%, PPV of 26.6%, NPV of 95.9%, and the missed diagnosis rate of HRV was 4.1%. Among the 180 patients who underwent liver transient elastography, 28 (15.6%) were classified as non-HRV by Baveno Ⅵ criteria (sensitivity 96.2%, specificity 17.5%, PPV 16.4%, NPV 96.4%, and missed diagnosis rate of HRV 3.6%), and 68 (37.8%) by expanded Baveno Ⅵ criteria (sensitivity 92.3%, specificity 42.9%, PPV 21.4%, NPV 97.1%, and missed diagnosis rate of HRV 2.9%). Conclusions: The RESIST-HCV criteria can spare approximately 30% of the compensated cirrhotic patients from gastroscopy, demonstrating certain clinical value for identifying low risk of variceal bleeding. |
| Keywords: Liver Cirrhosis; Esophageal and Gastric Varices; Platelet Count; Albumins; Liver Stiffness Measurement |
| 投稿时间：2025-06-23 |
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