The Diagnosis Of Cirrhosis And Its Complications By FibroScan

Objective:To definitude the effectiveness of FibroScan for assessing the degree of cirrhosis condition, to discuss its predictive value for happening of complications of cirrhosis,and to observe the the relationship between liver stiffness and EVBackground:Cirrhosis is the late stage of all sorts of chronic liver disease, and its Pathology's feature is that diffuse hepatic fibrosis, regenerative nodules and false flocculus forming. Clinically cirrhosis involves multisystem, of which liver function damaging and portal hypertension are two main manifestation, and often turns up severe complications such as gastrointestinal bleeding, hepatic encephalopathy and secondary infection at the late stage. Cirrhosis is a common diseasese and a kind of main causes to death. At present the diagnosis of cirrhosis and its complications mainly base on clinic. Although liver biopsy is currently considered the "gold standard" for diagnosing all sorts of chronic liver diseases, the examination itself has its own limitations and risks, limiting its acceptance. So many researchers have been searching for an non-invasive technique to replace liver biopsy. In recent years measuring liver stiffness by transient elastography is considered a non-invasive, painless, rapid, easy and objective technique to assess liver fibrosis quantitatively. The tissue volume collected by the probe is as 100 times as by liver biopsy, so TE is more representatively than liver biopsy. Transient elastography technique produced by Echosens, Paris is called FibroScan. Its principle bases on ultrasonic.It is not only used to diagnosis of hepatic fibrosis stage, but also to assess the degree of cirrhosis condition. And recent studies show that there are correlationship between the liver stiffness and Child- Turcotte - Pugh (CTP) scores, various complications, VE in patients with cirrhosis.Methods:Collect 176 patients with cirrhosis accepting the examinition of FibroScan who were from outpatients or hospitalized in First Hospital of Jilin University from September, 2009 to March, 2010 (including 110 patients with cirrhosis of HBV, 30 patients with cirrhosis of HCV, 18 patients with alcoholic cirrhosis and 8 patients with primary biliary cirrhosis,2 patients with autoimmune posthepatitic cirrhosis, 8 patients with cryptogenicher cirrhosis). Patients are between 18-75 years old, 122 male, average age is 50.91. 54 female, average age is 52.59. The liver stiffness measurment : Measurements were performed on the right lobe of the liver through intercostal spaces with the patient lying in dorsal decubitus with the right arm in maximal abduction. The tip of the transducer probe was covered with coupling gel and placed on the skin, between the rib bones at the level of the right lobe of the liver.Ten validated measurements were performed for each patient. The success rate was calculated as the number of validated measurements divided by the total number of measurements. The results were expressed in kilopascals (kPa). The median value was considered representative of the stiffness of the liver. Only procedures with at least 10 successful acquisitions and a success rate of at least 60% were considered reliable. In addition, the median value of successful measurements was considered representative of the liver stiffness in a given patient, only if the interquartile range (IQR) of all validated measurements was less than 30% of the median value. All statistical analyses were carried out with SPSS, version8.0 and differences were considered significant at P < 0.05.Results:of 176 patients with cirrhosis, there were 82 patients in grade A whose average LSM value were 28.53 Kpa, 61 patients in grade B whose average LSM value were 42.57 Kpa, 33 patients in grade C whose average LSM value were 67.89 Kpa. Comparing with each group, the result is p < 0.001, statistically significant. It illustrates that patients with cirrhosis ,who had different CTP scores, had different LSM value. More CTP scores,more LSM value. Of 176 patients with cirrhosis,there were 86 patients with no complication, whose average LSM value were 29.45 Kpa, 70 patients with ascites before, whose average LSM value were 50.06Kpa,25 patients with liver primary carcinoma, whose average LSM value were 53.11Kpa,12 patients with variceal bleeding whose average LSM value were 55.28Kpa. Average LSM value of patients with no complication were much higher than those with complications, p < 0.001, statistically significant,but comparing with each group patients with different complications, p>0.5, unsignificant statistically. And in this research, average LSM value of 86 patients with no complication was as nearly as that of patients in grade A ,what telled us that when LSM<28.53Kpa, the probability that appearing complications was small, belonging to grade A. In this experiment,61patients accepte endoscopy examination,of whom 41 patients had EV,and their average LSM value was 43.70 Kpa, 21 patients had no EV,and their average LSM value was 33.10 Kpa. average LSM value of patients with EV was much higher than that of patients with no EV, P < 0.001. AUROC was 0.675 for the diagnosis of EV (95% confidence interal 0.540 ~ 0.811). LSM value is 38 Kpa (sensitivity 53.66%, specificity 85.71%, PPV 88%, NPV 48.65% ). When LSM value >38 Kpa, the risk of EV is as 6.94 times as lower LSM values.Conclusion:1. More CTP scores, higher LSM value. Degree of cirrhosis condition can be assessed by FibroScan.2. LSM values of patients who had ascites ever, variceal bleeding or liver primary carcinoma were much higher than those of patients with no complicantion. Happening of complication can be predicted by FibroScan.3. more complications happen, higher LSM value is. Condition and prognosis of cirrhosis can be predicted by FibroScan.4. LSM value can predict EV. When LSM value>38Kpa, EV in middle degree or above will happen.