Predictive Value Of Serum Ammonia,Alanine Aminotransferase And γ-glutamyl Transpeptidase For Esophageal Varices In Cirrhosis

Objective:The purpose of this study was to explore the predictive value of serum ammonia,Alanine transaminase and γ-glutamyl transpeptidase for esophageal varices in cirrhosisMethod:92 patients with hepatic cirrhosis admitted to our hospital from January 2011 to September 2020 were included in the study,including 33 patients with hepatitis B cirrhosis,10 patients with hepatitis C cirrhosis,and 18 patients with alcoholic cirrhosis,1 case of autoimmune cirrhosis,3 cases of drug-induced cirrhosis,27 cases of cirrhosis of unknown cause.And collected clinical data of each patient,including gender,age,serum ammonia,total bilirubin（TB）,Aspartate Transaminase（AST）,Alanine transaminase（ALT）,γ-glutamyl transpeptidase（GGT）,serum albumin（ALB）,platelet count（PLT）,Hemoglobin（HB）,AAR,APRI,FIB-4,GPR,and liver function classification.According to the endoscopic grading standard of "Consensus on the Prevention and Treatment of Esophageal and Gastric Varices Bleeding in hepatic Cirrhosis with Portal Hypertension"（2008,Hangzhou）,92 patients with hepatic cirrhosis were divided into 19 patients with no/mild EV,and 73 patients with moderate/severe EV.The data were processed and analyzed by IBM SPSS 25.0 and Graph Pad Prism 8.0.1 statistical software.the differences of serum ammonia and other indicators between different esophageal varices groups were compared,and the correlation between blood ammonia,Alanine transaminase,γ-glutamyl transpeptidase and other indicators and esophageal varices was analyzed by Spearman analysis.The predictive value of these indicators for esophageal varices in patients with hepatic cirrhosis was evaluated according to the area under the ROC curves（AUC）.Result:1.There were significant differences in serum ammonia、ALT GGT and Hb among no/mild EV group and moderate/severe EV group,（p<0.05）.2.Serum ammonia was positively correlated with the esophageal varices in hepatic cirrhosis,（r=0.340,p=0.001）;ALT was negatively correlated with the esophageal varices in hepatic cirrhosis,（r=-0.263,p=0.011）;GGT was negatively correlated with the esophageal varices in hepatic cirrhosis,（r=-0.284,p<0.006）.There was no significant correlation between Hb and the degree of esophageal varices（r=-0.176,P=0.093）.3.The AUC of serum ammonia,GGT,and ALT for predicting moderate/severe EVs were 0.742、0.702、0.688,The sensitivity and specificity were 76.7%、68.4%,42.5%、94.7%,58.9%、84.2%.After performing the SPSS binary logistic regression on the above three diagnostic factors,after the ROC chart,the combined AUC（area）was 0.807,the sensitivity was 84.2%,and the specificity was 72.6%.Conclusion:1.Blood ammonia,ALT and GGT have significant predictive value for moderate/severe esophageal varices in patients with hepatic cirrhosis.2.The predictive value of blood ammonia in the degree of moderate/severe esophageal varices was better than ALT and GGT.3.The combined value of blood ammonia,ALT and GGT in predicting moderate/severe esophageal varices was better than independent prediction.