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Objective To assess the clinical value of endoscopic ultrasonography ( EUS ) for predicting esophageal varices ( EV ) progression in patients with hepatitis B virus ( HBV )-related hepatocirrhosis. Methods A retrospective cohort study was performed on 299 HBV-related hepatocirrhosis patients with light EV in Tianjin Second People′s Hospital admitted from September 2014 to September 2015. The diameter and number of peri-esophageal collateral veins ( ECV ) and para-ECV were measured and described by EUS. The first EUS examination time was the starting point, and the follow-up of 24 months or EV progression was the end. Risk factors of EV progression were evaluated by multivariate Cox regression model, and the predictive value of EUS for EV progression was analyzed by receiver operating characteristic ( ROC) curve. Results The cumulative incidence of EV progression was 2. 3％ ( 7/299 ) , 14. 8％( 44/297) , 33. 7％ ( 96/285) and 40. 0％ ( 120/273) at 6 months, 12 months, 18 months and 24 months of follow-up, respectively. The results of multivariate Cox regression analysis showed that the diameter of peri-ECV ( P=0. 0112, HR=1. 3232, 95％CI: 1. 0656-1. 6429 ) , the number of peri-ECV ( P=0. 0001, HR=1. 3666, 95％CI:1. 1634-1. 6052) and para-ECV diameter ( P=0. 0002, HR=1. 3641, 95％CI:1. 1558-1. 6100) were risk factors for EV progression. The use of nucleoside analogues treating HBV (P=0. 0020, HR=0. 4969, 95％CI: 0. 3186-0. 7751) and non-selective β-blockers descending portal venous pressure ( P=0. 0765, HR=0. 5732, 95％CI:0. 3097-1. 0611) were the protective factors for EV progression. The results of ROC curve analysis showed that the diameter of peri-ECV[ P<0. 001, area under the curve (AUC)= 0. 850, 95％CI: 0. 804-0. 895], the number of peri-ECV (P<0. 001, AUC=0. 831, 95％CI: 0. 784-0. 878), the diameter of para-ECV (P<0. 001, AUC=0. 924, 95％CI: 0. 895-0. 954) , and the number of para-ECV ( P<0. 001, AUC=0. 761, 95％CI: 0. 704-0. 817 ) had higher predictive value for EV progression;and the optimum cut-off values of each index were 1. 85 mm, 3. 5, 3. 35 mm, and 4. 5, respectively. The accuracies of prediction for EV progression were 76. 60％, 75. 19％, 84. 48％ and 70. 29％, respectively. Conclusion EUS can be used to predict EV progression in HBV-related hepatocirrhosis patients. Peri-ECV diameter>1. 85 mm, number>3. 5, and para-ECV diameter>3. 35 mm, number>4. 5 suggest a high risk of EV progression. For patients with HBV-related hepatocirrhosis complicated with mild EV, nucleoside analogues to anti-HBV and non-selective β-blockers to reduce portal hypertension can prevent EV progression.
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Objective@#To identify the independent risk factors of esophageal varices (EV) in cirrhosis by endoscopic ultrasonography (EUS), and further to establish a risk assessment model for predicting EV occurrence and evaluate the clinical predictive value of the model.@*Methods@#A retrospective cohort study was used in this study. Data of patients with cirrhosis without varicosity, who were hospitalized in Tianjin Second People's Hospital from September 2014 to March 2017 were collected. The location, diameter, and number of esophageal collateral circulation were measured by EUS. The non-selective beta blocker (NSBB) medication history and antiviral therapy were recorded. The time of the first EUS examination was taken as the starting point and the follow-up period was set up as 18 months. The end point was the occurrence of EV or the end of follow-up. The independent risk factors of EV occurrence were determined by univariate and multivariate logistic regression analysis, and the risk assessment model of EV occurrence was constructed. The predictive value of evaluation model for disease was studied by ROC analysis. Hosmer-Lemeshow goodness of fit was used to test the fitting efficiency of the evaluation model.@*Results@#A total of 638 subjects were recruited initially, 13 of them were lost in the course of the study. Finally, 625 cases were included in the study. Among them, 369 cases did not develop EV (the non-progress group) and 256 cases developed EV (the progress group). (1) Multivariate logistic regression analysis showed that 7 independent risk factors were selected into the risk assessment model of EV occurrence, and were assigned corresponding scores: no NSBB (3 points), no antiviral treatment (2 points), Child-Pugh stage B (1 point), the diameter of peri-ECV>2 mm (1 point), the number of peri-ECV≥5 (3 points), the diameter of para-ECV≥5 mm (4 points), and the number of para-ECV≥5 (4 points). (2) In the risk assessment model, the risk factor scores ranged from 1 to 4 with a total score of 0-18. The predicted incidence of EV increased from 0.003 to 1.000 with the increase of the score. (3) In the risk assessment model, the total risk score ≤2 was assigned into low-risk group, 3-5 into medium-risk group, and ≥6 into high-risk group. The actual EV incidence of each risk stratification was 2.78% in the low-risk group, 36.36% in the medium-risk group and 93.91% in the high-risk group, respectively. (4) The ROC analysis showed that area under curve (AUC) was 0.947 (P<0.05), suggesting that the risk assessment model had a good effect on predicting disease progression. Hosmer-Lemeshow test showed that P was 0.450, suggesting that the model fitted well.@*Conclusion@#The risk assessment model based on EUS can accurately predict the occurrence of EV, and is simple and easy to use. The model can provide scientific basis for the prevention and rational treatment of EV in liver cirrhosis.
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Objective To identify the independent risk factors of esophageal varices ( EV) in cirrhosis by endoscopic ultrasonography ( EUS) , and further to establish a risk assessment model for predicting EV occurrence and evaluate the clinical predictive value of the model. Methods A retrospective cohort study was used in this study. Data of patients with cirrhosis without varicosity, who were hospitalized in Tianjin Second People's Hospital from September 2014 to March 2017 were collected. The location, diameter, and number of esophageal collateral circulation were measured by EUS. The non-selective beta blocker ( NSBB) medication history and antiviral therapy were recorded. The time of the first EUS examination was taken as the starting point and the follow-up period was set up as 18 months. The end point was the occurrence of EV or the end of follow-up. The independent risk factors of EV occurrence were determined by univariate and multivariate logistic regression analysis, and the risk assessment model of EV occurrence was constructed. The predictive value of evaluation model for disease was studied by ROC analysis. Hosmer-Lemeshow goodness of fit was used to test the fitting efficiency of the evaluation model. Results A total of 638 subjects were recruited initially, 13 of them were lost in the course of the study. Finally, 625 cases were included in the study. Among them, 369 cases did not develop EV ( the non-progress group) and 256 cases developed EV (the progress group). (1) Multivariate logistic regression analysis showed that 7 independent risk factors were selected into the risk assessment model of EV occurrence, and were assigned corresponding scores:no NSBB (3 points), no antiviral treatment (2 points), Child-Pugh stage B (1 point), the diameter of peri-ECV>2 mm ( 1 point) , the number of peri-ECV≥5 ( 3 points) , the diameter of para-ECV≥5 mm ( 4 points) , and the number of para-ECV≥5 ( 4 points) . ( 2) In the risk assessment model, the risk factor scores ranged from 1 to 4 with a total score of 0-18. The predicted incidence of EV increased from 0. 003 to 1. 000 with the increase of the score. ( 3) In the risk assessment model, the total risk score≤2 was assigned into low-risk group, 3-5 into medium-risk group, and ≥6 into high-risk group. The actual EV incidence of each risk stratification was 2. 78％ in the low-risk group, 36. 36％ in the medium-risk group and 93. 91％ in the high-risk group, respectively. (4) The ROC analysis showed that area under curve (AUC) was 0. 947 (P<0. 05), suggesting that the risk assessment model had a good effect on predicting disease progression. Hosmer-Lemeshow test showed that P was 0. 450, suggesting that the model fitted well. Conclusion The risk assessment model based on EUS can accurately predict the occurrence of EV, and is simple and easy to use. The model can provide scientific basis for the prevention and rational treatment of EV in liver cirrhosis.
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Objective To assess the predictive value of endoscopic ultrasonography(EUS)for esophageal varices(EV)bleeding by studying the relationship between esophageal collateral veins(ECV), portal vein(PV)trunk with its main branches and EV bleeding. Methods A retrospective cohort study of 114 cases of moderate and severe EV was conducted. The ECV level was determined through EUS. At the same time,diameters of PV,azygos vein(AIV)and spleen vein(SV)were measured through EUS. The predictive value of ECV level and diameters of PV, AIV, SV for EV bleeding were assessed during the 1-year follow-up, which started from the first EUS examination to EV bleeding or the end of follow-up. Results Single factor Cox regression analysis showed severe peri-ECV varices had higher risk than mild in EV bleeding(HR=4.081,95%CI:1.833-9.086,P=0.001); severe para-ECV varices had higher risk than mild in EV bleeding(HR= 4.042, 95%CI:1.814-9.005,P= 0.001). Multivariable Cox retrospective analysis showed ECV level was an effective predictor for EV bleeding, when the peri-ECV and para-ECV were severe varices, EV bleeding risk increased to 3.831 3(P=0.004 3)and 3.493 3(P=0.003 1) times compared with mild respectively. Diameters of PV,AIV and SV could predict EV bleeding(PV AUC=0.959,P<0.001;AIV AUC=0.958,P<0.001;SV AUC=0.830,P<0.001).In addition, when diameter of PV>13.65 mm(sensitivity=0.94, specificity=0.84), AIV>8.65 mm(sensitivity=0.94, specificity=0.89),SV>9.45 mm(sensitivity=0.90, specificity=0.67), EV bleeding risk increased significantly. Conclusion EUS is helpful to predict the risk of moderate and severe EV bleeding, and severe varices of ECV,PV,AIV,and SV can be used as indicators to predict risk of EV bleeding.
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Objective To assess the relationship between the recurrence of esophageal varices fol?lowing endoscopic esophageal varix ligation (EVL) and esophageal collateral veins(ECV)under endoscopic ultrasound ( EUS) , and analyze the predictive value of EUS for recurrence of esophageal varices. Methods Sixty patients with cirrhotic portal hypertension combined with esophageal varices underwent EVL for eradica?tion of varices. Endoscopy and EUS were performed before ligation to detect and describe the type of esopha?geal varices, and grade, location, and the number of ECV. Over a 12?month period, variceal recurrence was examined. The statistical analyses were performed to assess the relationship between esophageal varices fol?lowing EVL and ECV. Results Of the 60 patients, 29 ( 48?3%) had variceal recurrence within 12 months after EVL. Univariate logistic regression analysis showed that severe peri?ECV ( OR=22?67;95%CI:4?37? 117?47, P<0?001) ,severe para?ECV( OR=16?31;95%CI:0?84?108?14, P=0?018) , multiple peri?ECV ( OR=22?67;95%CI:4?37?117?47, P<0?001) , and the presence of perforating veins ( OR=6?67,95%CI:1?46?30?43,P=0?014) were significantly related to the variceal recurrence after EVL. Multivariate logis?tic regression model showed that severe peri?ECV ( OR=24?39;95%CI:2?34?253?78,P=0?008) and mul?tiple peri?ECV (OR=24?39;95%CI: 2?34?253?78,P=0?008) severe para?ECV(OR=19?42; 95%CI:4?84?148?54,P=0?012) remained independent prognostic factors for variceal recurrence. The sensitivity and specificity of multivariate logistic regression model in predicting variceal recurrence were 89?2% and 90?5%, respectively (prognostic value AUC=0?946).The sensitivity and specificity were 86?4% and 87?7% in pre?dicting variceal recurrence( prognostic value AUC=0?871) . Conclusion Recurrence rate of esophageal var?ices after EVL is high. EUS can clearly depict ECV. Severe peri?ECV and multiple peri?ECV are significant and independent prognostic factors associated with variceal recurrence risk. EUS before EVL will help predict variceal recurrence after EVL.
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Objective To compare different Nrf2 expressions in glioblastoma cell lines and glioma stem cells (GSCs) from xenografts and to study the concentration of Nrf2 in nuclear. Methods GSCs were analyzed by immunofluorescence and different expressions of Nrf2 in glioblastoma cell lines and GSCs from xenografts were detected with real-time RCR and Western. Results GSCs were successfully isolated from xenografts of U251 and U87 cell lines. The percentage of tumor stem cells in total cells was 1.24%, and that was 1.63% in xenografts. Immunofluorescence indicated that Nrf2 was overexpressed in GSCs as compared with that in glioblastoma cell lines. Conclusion Nrf2 may be a potential biomarker and rational therapeutic target for GSCs.