Predictive Value Of FibroScan In Esophageal Varices In Patients With Liver Cirrhosis

Background and purpose:Patients with liver cirrhosis may have esophageal varices in the late stage,once varicose veins rupture,gastrointestinal bleeding,life-threatening.Therefore,timely assessment of the risk of esophageal varices in patients with liver cirrhosis is important for the treatment and prognosis of disease.At present,endoscopy is the" gold standard" for the diagnosis of esophageal varices,but because of its invasive examination,some patients are less tolerance,not conducive to disease screening and tracking monitoring.Therefore,it is very important to find a non-invasive method for detecting esophageal varices in patients with liver cirrhosis.FibroScan is an important method for the diagnosis of hepatic fibrosis,the greater the liver hardness(Liver stiffness measurement,LSM)value,the greater the degree of fibrosis,the higher the risk of complications of various kinds of liver cirrhosis.The results show that the LSM value is positively correlated with the portal vein pressure gradient.Therefore,we study the accuracy of FibroScan in predicting esophageal varices in patients with liver cirrhosis.Methods:The retrospective analysis of 55 patients with liver cirrhosis in the first hospital of Jilin university from October 2014 to August 2016.Each patient underwent FibroScan and endoscopic examination,according to the cases,the sex,age,height,weight,etiology of liver cirrhosis,history,and within 48 hours of routine blood test,liver function,kidney function,liver hardness,color Doppler ultrasound or CT results were collected.The accuracy of FibroScan in predicting esophageal varices in patients with liver cirrhosis was evaluated.Using SPSS 22.0 software for data analysis and drawing.Results:(1)The difference of LSM value,albumin,PTA,platelet and spleen thickness in patients with no,mild,moderate and severe esophageal varices was statistically significant(p<0.05).Age,sex,ALT and etiology were not statistically significant(p>0.05).The two comparative results showed that the LSM value of patients with moderate and severe varices was greater than that without varices,The albumin of patients with mild,moderate and severe varices were less than there is no,The count of PTA and platelet in patients with mild and severe varices was less than that in there is no group,and the the thickness of spleen value in mild and severe varices was greater than that in there is no group(p<0.05).Therefore,the level of LSM and spleen thickness increased,the decrease of albumin,PTA and platelet may be related to the presence of esophageal varices.(2)Univariate logistic regression analysis showed that LSM,albumin,PTA,platelet and spleen thickness were the factors of esophageal varices(p<0.05).Combined regression coefficient and OR value,the increase of LSM value and spleen thickness,the decrease of albumin,PTA and platelet count level is the risk factor of esophageal varices.Age,sex and ALT are not the influencing factors of esophageal varices(p>0.05).(3)By multivariate logistic regression analysis of LSM value,albumin,PTA,platelet and spleen thickness,the results showed that LSM value was the independent factor of esophageal varices,combined with regression coefficients and OR values,the risk of esophageal varices may increase by 51.7%per unit of LSM value.(4)With LSM and platelet as independent variables,the existence of esophageal varices(there was an assignment of 1,no assignment as 0)was used as dependent variable logistic regression analysis to establish a joint diagnostic model of two indexes,represented by variable PRE,arrive at Logit(PRE)=0.440×LSM-0.041×Platelet-2.424,According to the principle of logistic regression analysis,PRE=e-0.440×MSM-0.041×???-2.424/(1+e0.440?LSM-0.041×platelet-2.424).(5)The ROC analysis of LSM,platelet and combined diagnosis model showed that the sensitivity of combined diagnosis model,LSM value and platelet prediction of esophageal varices were respectively80.5%?75.6%?80.5%,specificity is 92.9%?92.9%?57.1%,The area under ROC curve is respectively 0.936(0.835,0.984),0.899(0.788,0.964),0.718(0.580,0.831),Cut-off values is 0.7802,18.2098 kPa,102×109/L.Conclusion:FibroScan has high predictive value for esophageal varices in patients with cirrhosis,LSM value is positively correlated with the risk of esophageal varices,combined use of platelet index can improve the accuracy of prediction.