| Objective:To analyze the diagnostic value of GPR(?-glutamyl transpeptidase and platelet ratio)and other non-invasive markers for esophageal varices of different etiologies.Methods:According to the inclusion and exclusion criteria,230 patients with cirrhosis of different etiology were screened out.All patients underwent detailed evaluation,laboratory tests,imaging,and endoscopy,also performed general clinical statistical analysis.Upper gastrointestinal endoscopy for esophageal varices was used as the gold standard.The degree of esophageal varices was divided into two groups: no/light group,medium/heavy group.Univariate analysis the related factors of esophageal varices.And then perform multi-factor non-conditional logistic regression analysis.The correlation between six non-invasive models and severe EV levels was analyzed.Then,Drawing ROC curves for six non-invasive indicators,the GPR,PC/SD,APRI,FIB-4,King's score,AAR,were evaluated to determine their efficacy in predicting EV.Assess the diagnostic effectiveness of GRR.According to whether or not they had severe esophageal varices,three groups of non-invasive models of GPR,PC/SD,king was performed by logistic analysis.The ROC curve of GPR combined with PC/SD predicted severe EV was further plotted.Divided into different Child-Pugh classes(Child-Pugh A and Child-Pugh B/C),Analysis of the AUC with GPR,PC/SD,APRI,FIB-4,King's score,AAR.Results:(1)Among 230 patients with cirrhosis,118 were HBV patients,37 were HCV patients,46 were PBC patients,and 29 were ALD patients.(2)Univariate analysis showed that the PLT,GGT,INR,total bilirubin,diameter of spleen,portal vein,and platelet to spleen were significantly correlated with the degree of esophageal varices.In addition,platelet counts in the moderate/severe esophageal vein group were significantly lower than those in the no/mild esophageal varices group,and total bilirubin levels were increased.(3)Multivariate unconditional logistic regression analysis showed that platelet count,portal vein diameter,platelet count/spleen diameter were statistically significant,P<0.05.(4)King(r=0.478 p<0.01),GPR(r=0.432 p<0.01),PC/CD(r=0.452p<0.01)had a moderate correlation with severe EV,and FIB-4(r=0.331 p<0.01).),APRI(r=0.358 p<0.01)had a low correlation with severe EV.AAR was not statistically significant(p=0.099).(5)The AUC of the six noninvasive models of GPR,PC/SD,APRI,FIB-4,King index,and AAR were 0.799,0.852,0.752,0.706,0.755,and 0.516,respectively.Among them,PC/SD has the highest predictive value in predicting severe esophageal varices.GPR has moderate diagnostic value,with the best cut-off value of0.432,sensitivity of 80.3%,specificity of 57.9%,PPV of 87.73%,and NPV of 43.52%.APRI,FIB-4,King index,and AAR showed moderate-low diagnostic value.(6)Non-invasive models of GPR,PC/SD,and King were analyzed by logistic review model.The results showed that GPR and PC/SD ratios could predict severe EV(p<0.05).(7)When GPR was combined with PC/SD,the area under the curve for predicting severe EV was 0.821,the sensitivity was 88.9%,the specificity was 67.8%,the PPV% was 53.3%,and the NPV% was 90.2%.Compared with GPR the diagnostic value is more higher.(8)Comparing the ROC of Child-Pugh A and Child-Pugh B/C,the results show that there are no significant differences between the six non-invasive models.Conclusion:1.Platelet count,portal vein diameter,and platelet/spleen diameter were independentrisk factors for esophageal varices.2.The GPR model has certain diagnostic value in predicting severe esophageal varices.It has higher diagnostic value than most other non-invasive models,but it can not replace the position of endoscope in accuracy.Its simple,economic and non-invasive characteristics can be used as the first-line Screening or follow-up of patients with cirrhosis.3.The value of combined use of GPR and PC/SD is higher than the value of GPR alone in predicting severe esophageal varices,and can be used as a supplementary measure of endoscopic screening. |
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