Correlation Research Of Hepatic Venous Press Gradient(HVPG)and Early Bleeding After Endoscopic Variceal Ligation(EVL)

Objective:Hepatic venous pressure gradient (HVPG) is the gold standard for diagnosis of portal hypertension. Endoscopic variceal ligation (EVL) is an important means of treating esophageal varices caused by cirrhotic portal hypertension. But for early rebleeding after EVL, especially with the correlation of the HVPG rarely have been reported. This study will research and analysis the related factors affect early bleeding after EVL, in particular the HVPG’s influence on early bleeding after EVL, aimed to investigate the predictive value of HVPG to early bleeding after EVL, to assist in guiding clinical treatment.Materials and Method:Collection of57patients medical records diagnosis of cirrhosis and esophageal varices,before EVL, they had a HVPG determination from Shandong Provincial Hospital of Eastern Hospital Gastroenterology period from October2010to February2013. Collected their HVPG value, etiology, previous history of bleeding, surgery and related treatment history, blood Routine, Coagulation indicators, liver function, biochemical indicators, ascites, hepatic encephalopathy and other complications occurred, as well as endoscopic findings and other relevant data, and6weeks after the ligation of the57patients whether bleeding and whether serious complications or death situation followed up. patients are divided into two groups according to whether bleeding during6weeks after ligation. by SPSS17, application the chi-square test and Wilcoxon test to analyze individual factors, whether there is a statistically significant, the application of the logistic regression model for multivariate analysis, to draw relevant factors risk and find a HVPG predictable indicators. And using ROC analysis to observed the predictive value of HVPG, and find its sensitivity and specificity when HVPG.≥17mmHg.Result:There are57patients have complete information, according to the follow-up, bleeding group have7patients, non-bleeding group have50patients (87.72%),the bleeding group HVPG is18.21±4.08mmHg, non-bleeding group HVPG is11.2±4.63mmHg, it was significant deviation between2groups(P=0.001).And it was significant deviation in ALB (P=0.032), HGB(P=0.049), PT(P=0.034), INR(P=0.034), liver function Child-Pugh classification (P=0.014),and postoperative complications (P=0.028). Through the logistic regression model, there was statistically significant only in the HVPG (P=0.048, OR value=1.417). After the tests of logistic regression model, when HVPG≥17mmHg, it was significantly different in the occurrence of bleeding and not bleeding(P=0.037, OR=18.75).According to ROC analysis, The area under the curve of HVPG about early bleeding after EVL is0.893, when HVPG≥17mmHg, the area under the curve is0.797, there is a certain accuracy, with a sensitivity of71.4%, specificity of88%,There was statistically significant in predicting early bleeding after EVL.Conclusion:Early bleeding after EVL was associated with HVPG, ALB, HGB, PT, INR, liver function Child-Pugh classification and postoperative complications. And HVPG is a independent factor affect early rebleeding after EVL,when the HVPG≥17mmHg,It significantly increased the risk of early rebleeding after ligation, which isl8.75times than when HVPG<17mmHg. HVPG, as a cut-off of predicting early bleeding after EVL,there is a certain accuracy, a high sensitivity and specificity.