Value Of Endoscopic Ultrasonography,Fibroscan,Acoustic Radiation Force Impulse Imaging,APRI And Their Combination In The Evaluation Of Early Cirrhosis

Objective To investigate the diagnostic value of endoscopic ultrasonography(EUS)、Fibroscan,acoustic radiation force impulse(ARFI)、aspartate aminotransferase-to-platelet ratio(APRI)and the combined for early liver cirrhosis,and further analyse the feasibility of Fibroscan instead of esophagogastroduodenoscopy(EGD)or endoscopic ultrasonography to predict early esophagogastric varices.Methods A total of three hundred and twenty-two hospitalized patients with chronic viral liver disease from March 2016 to April 2018 were enrolled.According to the clinical diagnosis,the patients were divided into two groups: chronic hepatitis group and the early liver cirrhosis group(Child-Pugh A grade).All patients were examinated by Fibroscan to detect liver stiffness measurement(LSM),ARFI to detect liver virtual touch tissue quantification(VTQ)value,esophagogastroduodenoscopy and EUS to detect esophagogastric varices,laboratory and imaging examination.Pearson correlation analysis was used to analyse Fibroscan and ARFI.EUS,Fibroscan,ARFI,APRI were analyzed to establish regression model by binary logistic regression.The areas under the receiver operating characteristic curve were used to evaluate the diagnostic efficacy of the above indicators and regression models for early liver cirrhosis,and further analysed the feasibility of Fibroscan instead of esophagogastroduodenoscopy or endoscopic ultrasound.Results 1.The gender composition,ALT and AST values were similar between the chronic hepatitis group and the early cirrhosis group,and the difference was not statistically significant(P>0.01).However,the age,LSM,liver VTQ and APRI of the early cirrhosis group were higher than those of the chronic hepatitis group,which were(47.3±11.7)years old vs(38.0±12.3)years old,10.4(7.8,17.3)kPa vs 6.1(5.2,8.4)kPa,1.71(1.48,2.07)m/s vs 1.25(1.14,1.43)m/s and 0.65(0.38,1.15)vs 0.38(0.26,0.62),the difference was statistically significant(P<0.01);The albumin and platelet counts of the early cirrhosis group were lower than those in the chronic hepatitis group,which were(44.8±4.3)g/L vs(46.8±3.6)g/L and(151.2±57.5)10^9/L vs(204.3±56.1)10^9/L,respectively,and the differences were statistically significant(P<0.01).2.Under the general gastroscope examination,the detection rate of esophagogastric varies in the early cirrhosis group was higher than that in the chronic hepatitis group,which was 44.2% vs 2.7%,the difference was statistically significant(P<0.01);Under the endoscopic ultrasonography examination,the detection rate of esophagogastric varies in the early cirrhosis group was also higher than that in the chronic hepatitis group,which was 76.7% vs 10.7%,and the difference was statistically significant(P<0.01).3.The area under the ROC curve(AUC)for the diagnosis of early cirrhosis by EUS,LSM,VTQ and APRI were 0.830,0.793,0.821,0.686,respectively.The corresponding sensitivity and specificity were 0.767 and 0.893,0.663 and 0.833,0.779 and 0.793,0.715 and 0.567,and the best cut-off values for the last three indicators were 8.95 kPa,1.465 m/s and 0.426,respectively.The regression model obtained by logistic regression analysis included EUS,LSM and VTQ.The AUC of the regression model for the diagnosis of early cirrhosis was 0.947,and the corresponding sensitivity and specificity were 0.878 and 0.867,respectively.4.Pearson correlation analysis between LSM and VTQ showed that there was a strong positive correlation between the two and the correlation coefficient r=0.668(P<0.01).5.Based on the results of general gastroscopy(presence or absence of esophagogastric varices)as the gold standard,the AUC of Fibroscan to predict esophagogastric varices was 0.682,the corresponding optimal cut-off value,sensitivity and specificity were 14.6kPa,0.400 and 0.897,respectively.Based on the results of endoscopic ultrasonography(presence or absence of esophagogastric varices)as the gold standard,the AUC of Fibroscan to predict esophagogastric varices was 0.681,the corresponding optimal cut-off value,sensitivity and specificity were 8.85 kpa,0.601 and 0.690,respectively.Conclusions 1.ARFI,Fibroscan,and APRI have certain diagnostic value for early cirrhosis.The diagnostic value is ARFI>Fibroscan>APRI,and ARFI is positively correlated with Fibroscan.2.The combined with EUS,Fibroscan and ARFI has higher diagnostic value for early cirrhosis,which can improve the diagnosis rate of early cirrhosis and reduce the rate of missed diagnosis.3.Endoscopic ultrasonography plays an important role in the early detection of esophagogastric varices,the sensitivity of which is higher than that of general gastroscope.Fibroscan instead of endoscopic ultrasound or esophagogastroduodenoscopy is not feasible to predict esophagogastric varices.