Clinical Values Of Non-invasive Diagnostic Technology For Assessing Esophageal Varices In Patients With Viral Hepatitis-related Cirrhosis

Objective:The aim of the study is to explore the clinical values of clinically common serum biochemical indicators,transient elastography,and abdominal ultrasonography in patients with viral hepatitis-related cirrhosis for the diagnosis of esophageal varices.Construct a new model to assess severe esophageal varices,compare the diagnostic efficacy of the model?RPR?GPR and PSR for severe esophageal varices in patients with viral hepatitis-related cirrhosis.Methods:Retrospective analysis of clinical data of patients with chronic hepatitis B cirrhosis and chronic hepatitis C cirrhosis who were treated in the Department of Gastroenterology,China-Japan Union Hospital of Jilin University from January 2016to August 2019.And collected clinical data of each patient.Age,gender,white blood cell count(WBC),red blood cell distribution width(RDW),platelet count(PLT),mean platelet volume(MPV),?-glutamyl transpeptidase(GGT),cholinesterase(CHE),albumin(ALB),total bilirubin(TB),prothrombin time(PT),total cholesterol(CHO),spleen diameter(SD),spleen thickness(ST),liver stiffness measurement(LSM)and Liver function classification.Patients were divided into no/mild EV group and moderate/severe EV group based on UGIE.The differences between the above indicators between the two groups of patients were compared,and the statistically significant indicators of single factor analysis were further subjected to two-class multivariate logistic regression analysis to obtain independent predictors of moderate/severe esophageal varices,and construct a new model to predict severe EV.Spearman rank correlation analysis was used to compare the correlation of RPR,GPR and PSR with severe EV,use area under the curve(AUC)to compare the model,RPR,GPR and PSR for assessing the diagnostic efficacy of severe EV in patients with viral hepatitis-related cirrhosis.The cutoff value was selected according to the method of the largest Youden's index,and the sensitivity,specificity,positive predictive value,and negative predictive value of each cutoff value calculated.Results:A total of 162 patients with viral hepatitis-related cirrhosis,compare the clinical indicators of no/mild EV group and moderate/severe EV group.PLT?WBC?RDW?GGT?TB?ST?SD?LSM and liver function grades are statistically different between the two groups(p<0.05).These indicators are further subjected to two-class multivariate logistic regression analysis.LSM,ST and PLT are independent predictors of moderate/severe EV,and a regression equation for assessing severe EV is established:logitP=?4.596-0.022×PLT(10~9/L)+0.115×LSM(kPa)+0.058×ST(mm).RPR,GPR and PSR all have a moderate degree of correlation with severe EV,the correlation coefficients are:0.521,0.584,-0.539(p<0.01),correlation coefficient intensity:GPR>PSR>RPR,in which the PSR is negatively correlated with severe EV.The AUC of model,GPR,PSR and RPR for predicting severe EV were 0.861,0.839,0.813,0.802.The Sn and Sp were 89%?71.9%,89%?74.2%,60.7%?94.5%,87.7%?62.9%,The model has the highest predictive value,followed by GPR,PSR,and RPR.Conclusion:1.LSM,ST and PLT are independent predictors of moderate and severe EV in patients with viral hepatitis-related cirrhosis.2.GPR,PSR and RPR have higher predictive value for severe EV in patients with viral hepatitis-related cirrhosis.3.The predictive value of the model composed of LSM,ST and PLT for severe EV is better than GPR,PSR and RPR in patients with viral hepatitis-related cirrhosis.