| Background:B-viral cirrhosis is one of the common diseases of digestive system departmentin our country, and esophageal variceal bleeding (EVB) is the most seriouscomplication of cirrhosis. EVB with B-viral cirrhosis is a common acute disease withhigh fatality rate in digestive system department. So, it is very important to find amethod of the prediction of EVB with B-viral cirrhosis. The noninvasive examinationmethod of the all prediction methods is a clinical research hotspot in liver disease athome and abroad. At present, there are two categories of the noninvasive examinationmethods which are suitable for clinical. One is the portal system examination indexwhich is based on imaging, the other one is laboratory examination index. Imaging ismainly for the ultrasound system, the indexes contain the width of portal vein, splenicvein width, spleen thickness and the oblique diameter, portal venous blood flowvelocity, etc. The laboratory examination indexes contain the platelet count,prothrombin time, albumin, white blood cell count, and so on.The sensitivity,accuracy, specificity of the single noninvasive examination indexes to predictbleeding is not satisfied. In recent years, foreign scholars have put forward the P2/MSvalue [platelet count2/monocyte frarction(%)×segmented neutrophilfraction(%)]which is based on the blood routine examination. This is a newnoninvasive reliable index to predict the EBV with B-viral cirrhosis. This study aimsto joint the P2/MS value, width of portal vein and liver function Child grading toestablish a scoring system to predict the EBV with B-viral cirrhosisObjective:Decompensated liver cirrhosis after hepatitis B patients were divided intobleeding and non bleeding group, the non bleeding group is divided into high-risk andlow-risk group.Through comparing the results of P2/MS value, width of portal veinand Child grading of the three groups, evaluate the prediction value of the threeindexes to EVB with B-viral cirrhosis, and establish a noninvasive bleeding scoring system for prediction of EVB.Methods:Form December2012to December2013, the patients in the first affiliatedhospital of nanchang university digestive internal medicine were enrolled. They werediagnosed with B-viral cirrhosis which is in decompensation period, whetherbleeding or not.We collected the blood routine, portal venous ultrasound results andChild grading of liver funtion,then analysised to determine the three indexes forpredicting bleeding have value or not. Analysis of the ROC curve of P2/MS value andthe width of portal vein, then find the best cutoff value of bleeding and non bleeding.Through their respective cutoff value of P2/MS value, the width of portal vein, andjoined Child grading scoring system to establish a noninvasive prediction bleedingscoring system. According to the new scoring system, work out all the scores into thegroup of patients, to T test of three groups of patients after scoring, it is concludedthat werther statistical significance or not. For groups with statistical significance inthe ROC curve analysis, obtain the best cutoff value, the total value is greater than thebest cutoff value of patients diagnosed with bleeding. We calculate the scoring topredict the accuracy and misdiagnosis rate.Results:1.105patients were enrolled, among them,60patients were diagnosed withbleeding,45patients non bleeding. All patients underwent gastroscopy for endoscopicgrading. According to the result of gastroscopy, non bleeding group was divided intohigh-risk and low-risk groups. Low-risk group of24cases,21cases of high-riskgroup. In the high-risk group,20cases (95%) of the men, women in1case (5%), theonset of the average age was49.95+9.052; in the low-risk group,17cases (71%) ofthe men,7cases of women (29%), the onset of the average age was47.92+11.447;in bleeding group,36cases (60%) of the men and women in24cases (40%), theaverage age was45.55+10.912. Gender difference in three groups of P values <0.05,with statistical significance. The onset age of P values>0.05, no statisticalsignificance.2. Bleeding and non bleeding group, high-risk and low-risk groups, bleeding and high-risk group of P2/MS value of P values <0.05, with statistical significance.Bleeding group and non bleeding group, high-risk and low-risk groups of the widthof the portal vein of P values <0.05, with statistical significance. Bleeding groupand high-risk group of the width of portal vein of P value>0.05, no statisticalsignificance.3. High-risk and low-risk group liver function Child grading of P value <0.05,with statistical significance. Bleeding group and non bleeding group, bleeding groupand the high-risk group of liver function Child grading of P value>0.05, nostatistical significance.4. Through in the group of bleeding and non bleeding ROC curve analysis, thebest cutoff value of P2/MS value was8.9and24.65, respectively. The best cutoffvalue of width of portal vein was1.05and1.05. P2/MS value>24.65,8.9-24.65,<8.9respectively named1points,2points,3points; width of portal vein <1.05cm,1.05--1.55cm,>1.55cm respectively named1points,2points,3points;and liverfunction Child class A,B,C grading respectively named1points,2points,3points.The three values for each selected cases in addition, then established the noninvasiveprediction of bleeding score system. The system a total of9points, the lowest pointsis3points.By ROC curve analysis of the scoring system, the optimal cutoff value is5.5, thearea under the curve is0.95, with statistical significance (P <0.001), the sensitivity ofthe point is90.5%, specificity is83.3%. The diagnostic accuracy of the scoringsystem in bleeding group is92%, the misdiagnosis rate is8%, the diagnostic accuracyof non bleeding group is50%, the misdiagnosis rate is50%.5. The scoring system is compared with the P2/MS value separately predictbleeding. P2/MS value separately predict bleeding with a sensitivity of70%, aspecificity of36%; Scoring system to predict bleeding with a sensitivity of92%, aspecificity of50%.Conclusions:P2/MS values will be used as a separate index to predict EVB with B-viralcirrhosis, the sensitivity and specificity is high. A new noninvasive prediction of bleeding scoring system which composed ofP2/MS value, width of portal vein, liver function Child grading, can be used as amethod to predict EVB with B-viral cirrhosis. Its sensitivity and specificity are higherthan P2/MS. |
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