Retrospective Study Of Noninvasive Niagnosis Of Esophageal Varices In Patients With Chronic Hepatitis B

BackgroundEsophageal varices for the Chinese people have a special significance,because China is the first major epidemic of hepatitis B,Many patients eventually entered the stage of advanced liver cirrhosis.EV is the most common complications of chronic hepatitis B cirrhosis,more sudden hematemesis and(or)hematochezia,often for massive bleeding,palpitation,chest tightness,fatigue and other symptoms,caused by severe hemorrhagic shock,induced hepatic encephalopathy.EV rupture bleeding is the most common and high mortality complication of liver cirrhosis.After the first hemorrhage,70% of patients will bleed again,so it is very important for the early detection and treatment of EV.Clinical diagnosis of EV is widely used in the diagnosis of upper gastrointestinal endoscopy,endoscopic diagnosis of invasive,easy to appear in the process of acute bleeding,anesthesia accident and other complications,and the patient is more difficult to tolerate.Noninvasive serological model is the blood routine,liver function,blood coagulation four indices obtained by the relevant formula to check up the model,concerned in recent years,which has been included in some individual guide.Determination of Fibroscan(FS),which is based on ultrasound,has been widely used in clinic.AIM:Comparison of noninvasive serological model(AAR,APRI,GPRI,S,index,API,Fibro-Q,King and FS)for predicting chronic hepatitis B patients with severe esophageal varices,To investigate the diagnostic value of the combination of the serological model.METHODS:A total of 140 patients with chronic hepatitis B participants underwent endoscopy,blood routine,liver function,blood coagulation four check.AST/ALT(AAR model)ratio,AST/PLT ratio(APRI model),GGT/PLTratio(GPRI model),GGT-PLT-ASB ratio(S-index model),age-PLT related index(API model),age-AST-INR-PLT-ALT ratio(Fibro-Q model)and age-AST-INR-PLT ratio(King model)were evaluated.The liver stiffness was measured by transient elastography(FS).Upper gastrointestinal endoscopy for esophageal varices was used as gold standard.The data were used to establish the model and analyzed using the receiver operating curve.RESULTS:The area under the curve of AAR,GPRI,S-index,APRI,API,Fibro-Q,King and Fibroscan in predicting severe esophageal varices were 0.430,0.800,0.801,0.777,0.612,0.750,0.804,0.890,respectively.The value of GPRI,S-index,King and FS was more significant than AAR,APRI,API,Fibro-Q,its sensitivity and specificity were 0.805,0.586,0.878,0.586,0.657,0.951,0.747,respectively,It can be seen that the sensitivity and specificity of FS are high,the correlation is good,and the predictive value is the best..The area under the combination of Fibroscan and S-index/King/GPRI were 0.899(P<0.01),0.892(P<0.01),0.891(P<0.01),respectively,Compared with the single application of GPRI,S-index,king,the difference was statistically significant.CONCLUSION:These noninvasive examination(GPRI,S-index,King and Fibroscan)had good diagnostic performance for prediction of esophageal varices.GPRI,S-index,King slightly worse than FS,and APRI,API,Fibro-Q for severe esophageal varices predictive value in general,AAR did not find significant diagnostic value.Fibroscan and S-index/King/ GPRI combined together had higher value than the single application in Fibroscan prediction,which could be used as a good supplement alternative to endoscopy.