Clinical Study Of Fibroscan Combined With Multi-parameters In Predicting High Risk Esophageal Varices In Hepatitis B Cirrhosis

Objective:To explore the clinical value of Fibroscan combined with multi-parameters in predicting high-risk esophageal varices(high-risk EV)in patients with hepatitis B cirrhosis.Methods:Patients with hepatitis B cirrhosis who were treated in the Gastroenterology Department of Shanxi Provincial People’s Hospital from October 2019 to December 2021 were selected.According to the results of gastroscopy,they were divided into non-high-risk EV group and high-risk EV group.The comparison of measurement data between the two groups were performed by independent samples t test or Mann-Whitney U test;the comparison of count data between the two groups were performed by the chi-square test.Logistic regression was used to analyze the relationship between LSM,PC/SD,ALBI scores and high-risk EV.And a regression equation,namely a noninvasive prediction model,was established and tested.Receiver operating characteristic curve(ROC curve)was drawn to evaluate the predictive value of LSM,PC/SD,ALBI score and non-invasive model Y,and the cut-off value was obtained.The De Long method was used to determine whether the ROC of the above four non-invasive indicators had statistical difference.Results:A total of 243 patients with hepatitis B cirrhosis were contained in this study,including 121 patients in the high-risk EV group.There were significant differences in PLT,ALT,Alb,TBil,DBil,PT,INR,spleen diameter and Child-Pugh grade between the high-risk EV group and the non-high-risk EV group(all P<0.05).Compared with the non-high-risk EV group,the high-risk EV group had higher LSM value(Z=-9.945),higher ALBI score(t=-12.472),and lower PC/SD(Z=-10.611),and the differences were statistical significant(P<0.05).The area under the ROC curve(AUC)of LSM was 0.869(95%CI: 0.820-0.909),and the cut-off value was >20.7k Pa;the AUC of PC/SD was0.894(95%CI: 0.848-0.930),and the cut-off value was ≤544.87;the AUC of the ALBI score was 0.856(95%CI: 0.806-0.898),and the cut-off value was >-2.07;and there was no significant difference in AUC among the three parameters.A non-invasive model for predicting high-risk EV in hepatitis B cirrhosis was constructed: Y=6.102+0.144 ×LSM+2.543×ALBI score-0.008×PC/SD.The AUC of this model was 0.961,the cut-off value was >-0.94,and the sensitivity was 96.69%,the specificity was 82.79%,the positive predictive value was 84.8%,the negative predictive value was 96.2%,and the accuracy was 89.71%.The diagnostic AUC of the model was significantly greater than the other three parameters(P<0.05).Conclusion:LSM,PC/SD and ALBI scores all have certain diagnostic value for the high-risk EV in hepatitis B cirrhosis patients.The non-invasive model Y constructed by Fibroscan combined with PC/SD and ALBI scores was better in predicting high-risk EV,and could be used in clinical screening and assisting in the diagnosis of high-risk EV in patients with hepatitis B cirrhosis,thereby reducing medical costs and improving patients compliance.