Diagnostic values of noninvasive parameters in liver cirrhosis with severe esophageal varices / 中华消化杂志

ABSTRACT

Objective To analyze the correlation between Doppler ultrasound parameters, blood biochemical indexes and the severity of esophageal varices (EV), and to explore the values of them in the diagnosis of severe EV.Methods A total of 102 hospitalized patients with liver cirrhosis was consecutively collected.All patients underwent endoscopic examination to determine the presence and severity of EV, then they were divided into moderate/severe EV group (n=78) and non/mild EV group (n=24).Congestion index of the portal vein (PV-CI), damping index of hepatic vein(HV-DI), hepatic vein arrival time(HVAT) and intrahepatic circulatory time (IHCT) were measured by Doppler ultrasound and contrast-enhanced ultrasound.And at same time, the level of yon Willebrand factor antigen (vWF-Ag) and soluble CD163 (sCD163) in peripheral blood were detected by enzyme linked immunosorbent assay (ELISA) method.The differences of these parameters between two groups were compared by independent samples t-test or Mann-Whitney rank sum test.The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) of related parameters in the prediction of EV were calculated according to receiver operating characteristic(ROC) curve.Results Ultrasound parameters PV-CI, HV-DI and peripheral blood vWF-Ag, sCD163 levels of moderate/severe EV group were all significantly higher than those of none/mild EV group 0.11 (0.05) cm · s vs 0.07(0.03) cm· s;0.72±0.11 vs0.52±0.12;1 824.00(558.00) U/Lvs 1 533.80(311.50) U/L;(72.57±10.94) μg/L vs (57.91±10.40) μg/L;Z=-4.949, t=-7.759, Z=-5.420, t=-5.804, all P＜0.05).However HVAT and IHCT were significantly shorter than those of non/mild EV group (17.00(4.25) s vs 27.78(6.75) s;(6.62±1.85) s vs (9.33±2.26) s, Z=-3.822, t=5.820, both P＜0.05).ROC curve analysis showed that the areas under the ROC curve of HVDI, vWF-Ag and sCD163 predicting moderate/severe EV were all more than 0.8, the appropriate cutoff value of HV-DI, vWF-Ag and sCD163 was 0.64, 1 693.8 U/L and 63.98 μg/L, respectively.The sensitivity were all more than 75％,PPV were all greater than 90％ and DA were all more than 80％.Conclusion HV-DI, peripheral blood vWF-Ag and sCD163 levels can be taken as noninvasive parameters, which can effectively predict the presence of severe EV, facilitate early detection of these high-risk bleeding patients and prevent bleeding.