Esophageal Varices Evaluation In Types Of TCM Syndrome In Cirrhotic Patients With Fibroscan

Objective: To evaluate the accuracy of Transient Elastography(Fibroscan) and reasonability of Fibroscan cutoff value in cirrhotic patients with esophageal varices(EV) under different types of Traditional Chinese Medicine(TCM) syndrome of liver cirrhosis(LC), which will be helpful clinical diagnosis and descent the adverse effect of Gastrointestinal Endoscopy(GIE);we hope to hunting for the diagnostic criteria of syndrome including objectivity,applicability and practicality for guiding clinical treatment through the study of this research.Metheods: We searched the Pub Med, Medline, Embase, Cochrane Library, CBM, Wan Fang, CNKI databases for relevant studies published from Jan.2006 to Jan.2016. Study selection and data extraction were performed. Revman5.0 software was used to assess the quality of studies selected by authors and Meta Disc1.4 software was applied to test the heterogeneity of studies and perform the meta analysis for sensitivity(Sen), specificity(Spe), positive likelihood ratio(PLR), negative likelihood ratio(NLR),diagnostic odds ratio(DOR) with appropriate(fixed or random) effect model. Area under the curve(AUC) was calculated when A summary receiver-operating characteristic(SROC) curve was constructed, and investigated the heterogeneity of papers with meta regression and subgroup analysis and sensitivity analysis. Furthermore,Stata12.0 software as a approach to assess the publication with Begg and Egger test. Secondly in order to explore the accuracy of Fibroscan in cirrhotic patients with esophageal varices under different types of Traditional Chinese Medicine(TCM) syndrome of LC, we collected 124 cirrhotic patients met qualifying criteria in the divisions of hepatic disease and gastrointestinal disease of the second affiliated hospital of Xi An Jiao Tong University from Aug.2015 to Jan.2016; The syndrome types of TCM were diagnosed by TCM specialists. The GIE physician and Fibroscan technologist were blind to patients’ EV, when they received upper endoscopy and Fibroscan independently, SPSS19.0 and Med Calc softwares were used to address the datum. We drew the reiceiver operating characteristic curves(ROC) and calculated the area under the curve(AUC)of ROC and compared AUC with Z test after assessing the EV in different syndrome types of TCM with Fibroscan.Results: 1.The pooled sensitivity, specificity, PLR, NLR, DOR, AUC of Fibroscan for the presence of EV diagnosis were 0.84(95% CI, 81. 0% to 86. 0%), 0.62(95% CI, 58. 0% to 66. 0%), 2.3(95% CI,1.81 to 2.94), 0. 26(95% CI,0.19 to 0.35), 9.33(95%CI: 5.84 to 14.92), and 0.8262; The predicting cutoff of Fibroscan for the presence of EV was waving from12.0-29.7kpa. Meta regression and subgroup analysis suggest that the heterogeneity was from etiological factor probably, And sensitivity analysis implied that the heterogeneity was affected by two papers(Stefanescu2011 and Calvaruso2013).Funnel figure indicate Fibroscan diagnosis for the presence of EV were influenced by publication bias.2.The pooled sensitivity, specificity, PLR, NLR, DOR, AUC of Fibroscan for the Large EV diagnosis were 0.78(95% CI,75.0%-81.0%), 0.76(95% CI,73.0%-78.0%), 3.03(95% CI,2.38 to 3.86),0. 30(95% CI,0. 23 to 0. 39), 10.69(95%CI, 6.81 to 16.78), and 0.8321; The predicting cutoff of Fibroscan for the Large of EV was waving from19.0 to 48.0kpa. Meta regression and subgroup analysis suggest that the heterogeneity was from year factor probably, And sensitivity analysis implied that the heterogeneity was affected by three papers(Stefanescu2011, Calvaruso2013 and Hu2015).No publication bias in Fibroscan diagnosis for the Large EV.3.According to the different types of TCM syndrome classification, the syndrome ware ranked by the proportional distribution of patients from most to least; Stagnation of Liver-QI, Internal Accumulation of Dampness-Heat, Internal Resistance of Dampness, Obstruction of Collaterals by Blood Stasis, Spleen-Kidney Yang Insufficiency and Liver Kidney Yin Deficiency. Stagnation of Liver-QI and Internal Resistance of Dampness were shown predominantly by Child-Pugh A and the presence of no or mild EV; Internal Accumulation of Dampness-Heat was manifested Child-Pugh B and mild or moderate EV; Furthermore, Obstruction of Collaterals by Blood Stasis, Spleen-Kidney Yang Insufficiency and Liver Kidney Yin Deficiency predominated by Child-Pugh C and moderate or significant EV.4.Stagnation of Liver-QI, Internal Accumulation of Dampness-Heat, Internal Resistance of Dampness were high accuracy of diagnosis in the Fibroscan for the presence of EV; The diagnostic accuracy of Stagnation of Liver-QI was lower comparing others. However, the three types of TCM syndrome had no statistical significance to the ability of diagnosis. Also we could not differentiate the types of TCM syndrome by cutoff and AUC value. Stagnation of Liver-QI, Internal Accumulation of Dampness-Heat, Internal Resistance of Dampness were moderate accuracy of diagnosis in the presence of EV; The diagnostic accuracy of Stagnation of Liver-QI was lower comparing others. However, the three types of TCM syndrome had no statistical significance to the ability of diagnosis according to the AUC comparison, also we could not differentiate the types of TCM syndrome by cutoff and AUC value.5.Stagnation of Liver-QI, Internal Resistance of Dampness in the large EV were higher sensitivity and lower specificity,and Liver Kidney Yin Deficiency and Obstruction of Collaterals by Blood Stasis were lower sensitivity and AUC in contrast to other types of TCM syndrome. Nevertheless, the six types of TCM syndrome were moderate accuracy of diagnosis in the large EV and had no statistical significance to identify the ability of diagnosis according to the AUC comparison by Z test. Thus, we could recognize the types of TCM syndrome by cutoff and AUC value to clinical practice.Conclusion: 1.The moderate diagnostic accuracy and ability to the EV by transient elastography; the higher effective of prediction in large EV in contrast to presence of EV.2. The moderate diagnostic accuracy and ability to the EV in different types of TCM syndrome that were no difference to accuracy, Fibroscan can not distinguish the types of syndrome except EV assessment.