Correlation Between Degree Of Esophageal-gastric Varices And Portal Hypertension Parameters And The Degree Of Liver Function In Patients With Hepatic Cirrhosis

The development of esophageal-gastric varices (EGV) is one of the major complications of hepatic cirrhosis. It is life-threatening once the EGV bleed from ruptured varices, and lead a high mortality. EGV can be diagnosed by endoscopy, which can observe the location, appearance, color hue, and red-color sign of EGV directly, and judge the risk of variceal hemorrhage, and give treatment promptly.In 1996 the American Association for the Study of Liver Disease suggested repeating endoscopy at 2-3 year intervals in patients without varices and at 1-2 year intervals in patients with small varices so as to evaluate the development or progression of this feature. Undoubtedly, this psycho and economic burden will increase due to the repeating endoscopy of patients with hepatic cirrhosis.Aims: To discuss the correlation between the degree of EGV and parameters related to portal hypertension, Child-Pugh grading. And to identify parameters which might non-invasively predict the degree of EGV in patients with hepatic cirrhosis, in order to avoid unnecessary repeating endoscopy.Methods: The retrospective analysis was performed in 196 patients who were diagnosed with hepatic cirrhosis in Gastroen- terology department of our hospital from Jan.2002 to Jan.2006. All 196 cases were divided into three groups according to the degree ofEGV diagnosed by endoscopy: small varices (S), midrange varices (M), large varices (L). The diameter of portal vein (PV) and splenic vein (SV), splenic length (SL), splenic thickness (ST), and platelet count (PC) were recorded, and Child-Pugh score (CPS), Child-Pugh grading (CPG), splenic index (SI=SL×ST), PV/SV and PC/SI were calculated for all patients. To observe:①the relationgship between the degree of EGV and sex, age, etiopathogenisis of all patients;②the difference of PV, SV, SI, PC, PV/SV, PC/SI and CPS in S, M, L groups;③t he constituent ratio of Child-Pugh's class A, B, C in S, M, L groups;④the difference of PV, SV, SI, PC, PV/SV, PC/SI, CPS and CPG between merely esophageal varices (EV) group and esophageal varices combined with gastric varices (E&GV) group in L group;⑤to assess parameters cut off with the best sensitivity, specificity and confidence index (CI) for a diagnosis of midrange and large varices;⑥to sieve non-invasive parameters which can predict the midrange and large varices perfectly by receiver operating characteristic (ROC) curves.Results:①There is no statistical difference on sex, age, etiopathogenisis among S, M, L groups.②A ll the parameters are different among S, M, L groups: PV (F=5.22, P<0.01), SV (F=24.13, P<0.01), SI (F=40.73, P<0.01), PC (F=23.73, P<0.01), PV/SV (F=13.48, P<0.01), PC/SI (F=33.97, P<0.01), CPS (F=7.84, P<0.01). Further comparisons show that SI, PC/SI are different among threegroups; PV, CPS are different between S and L group; SV, PV/SV are not different between S and M group; PC is not different between M and L group.③The constituent ratio of Child-Pugh's class A, B, C in three groups: class A account 43.48%, class B account 43.48%, class C account 13.04% in S group, the counterparts in M group are 23.08%, 61.54%, 15.38%, and in L group are 15.38%, 53.85%, 30.77%.④There are no difference on PV, SV, SI, PC, PV/SV, PC/SI, CPS and CPG between EV group and E&GV group in L group.⑤The area under the receiver operating characteristic curve (AUC) values generated by ROC curves for PC, PV/SV and PC/SI are 0.781, 0.655 and 0.870. The sensitivity and specificity of PC/SI <0.97 in predicting midrange and large varices are 89.4% and 70.6%, the CI is 0.870, while the CI of PC and PV/SV are 0.781 and 0.655.Conclusions:①The sex, age and etiopathogenisis of cirrhotic patients are not associated with the degree of EGV.②SI and PC/SI are better parameters that can classify the small, midrange and large varices. The larger the varix is, the bigger the SI is, and the smaller PC/SI is.③The degree of EGV can not be reflected by PV, SV, PC, PV/SV and CPS alone.④The larger the EGV is, the less the Child-Pugh's class A account, while the more the Child-Pugh's class C account.⑤There is no influence in the correlation between degree of EGV and portal hypertension parameters and the degree of liver function whether there it combined with gastric varices.⑥PC andPC/SI can predict midrange and large varices. PC/SI, C index is the biggest of all the parameters, is an ideal non-invasive parameter which can predict the midrange and large varices.⑦When PC/SI <0.97, the sensitivity (89.4%) and specificity (70.6%) are highest in predicting midrange and large varices.