Association Between The Severity Of Liver Cirrhosis With Esophageal Varices And Bleeding Risk Predicted By FibroScan Combined With APRI

Objective:Fibro Scan combined with aspartate aminotransferase and platelet ratio index(APRI)were used to detect the correlation between the degree of esophageal varices and the risk of rupture and hemorrhage in patients with liver cirrhosis,and its diagnostic predictive value.Methods:1.210 patients with viral hepatitis cirrhosis which diagnosed according to the criteria of the eighth edition of "Internal Medicine" teaching materials published by People's Health Publishing House in 2013 were selected from the third affiliated hospital of Henan University of Science and Technology between 2013.1.1-2015.10.1.The 210 patients were divided into no,mild,moderate and severe esophageal varices group according to the endoscopic examination and the diagnostic criteria all in line with the Chinese Medical Association digestive endoscopy branch esophageal variceal group developed the "gastrointestinal varicose veins and bleeding endoscopic diagnosis and treatment of standardized trial program(2009)".At the same time,The 210 patients with cirrhosis were divided in to esophageal and gastric venous hemorrhage group(referred to as bleeding group),no esophageal and gastric venous hemorrhage group(referred to as no bleeding group)according to the guideline of the Chinese Medical ssociation of liver disease,digestive medicine branch,digestive endoscopy branch of the"cirrhosis of the portal vein hyperthermia esophageal variceal bleeding in 2008.2.At the same time,the values of Fibro Scan elasticity,Aspartate aminotransferase(AST)and platelet(PLT)were measured in all patients enrolled in the same period(3 days),and then calculate the APRI value.3.The SPSS22.0 statistical software were used in data process,The data are described by mean ± standard deviation(),t test was used for the comparison of the two groups of quantitative data,multiple quantitative data comparison by the normality and variance test,The variance was calculated using the one-way ANOVA,and the homogeneity of variance was calculated using the Kruskal-Wallis test;Correlation analysis using Spearman correlation analysis.The Receiver Operating Characteristic Curve(referred to as ROC curve)was drawn with the endoscopic examination as the gold standard,the optimal value of the sum is the value corresponding to the maximum value of sensitivity and specificity,and the accuracy of the diagnosis result is evaluated according to the area under the receiver operating characteristic curves(AUC).Results:1.The mean liver stiffness measure(LSM,That is,Fibro Scan elasticity)were(17.94± 3.72)k Pa,(21.69 ± 6.17)k Pa,(26.58 ± 6.69)k Pa,(30.63 ± 7.94)k Pa in patients with mild,moderate and severe esophageal varices respectively.The mean values of APRI were 1.40 ± 0.5,1.81 ± 0.58,2.5 ± 0.62,3.53 ± 1.0,The difference between the four groups was statistically significant(P<0.05).The area under the ROC curve of LSM,APRI and LSM + APRI in patients with mild esophageal and esophageal varices was 0.856,0.900 and 0.906,respectively,and the sensitivity were 0.632,0.847 and 0.889,respectively.The area under the ROC curve of LSM,APRI,LSM + APRI in patients with moderate and above esophageal varices were0.857,0.924 and 0.923,respectively,and the sensitivity was 0.692,0.744 and0.769,respectively.The area under the ROC curve of LSM,APRI,LSM + APRI in patients with severe esophageal varices were 0.801,0.903,0.901,and the sensitivity were 0.833,0.867 and 0.783,respectively.2.The mean values of LSM were(22.87 ± 6.95)k Pa,(28.49 ± 9.46)k Pa,the mean values of APRI were(2.13 ± 1.01)and(2.99 ± 1.11)in bleeding group and no bleeding group respectively,there was significant difference between the two groups(P<0.05).The AUC of LSM,APRI,LSM + APRI in patients with hemorrhagic cirrhosis were 0.669,0.727 and 0.722,respectively.3.LSM and APRI had a positive correlation with endoscopy,the correlation coefficient(rs)was 0.637,0.754 respectively(P<0.01).Conclusion:1.Fibro Scan combined with APRI has an effective diagnostic and predictive value for the degree of esophageal varices in patients with viral hepatitis and posthepatitic cirrhosis.2.Fibro Scan combined with APRI has an effective diagnostic and predictive value for the risk of esophageal variceal bleeding in patients with viral hepatitis and posthepatitic cirrhosis.