The Value Of Ultrasonography In Evaluating The Risk Of Upper Gastrointestinal Hemorrhage In Patients With Cirrhosis And Portal Hypertension

ObjectiveTo explore the clinical value of Gray-scale ultrsound and Doppler ultrasound in evaluating the risk of upper gastrointestinal bleeding in patients with cirrhosis and portal hypertension.Methods83 cirrhotic patients who were hospitalized in hepatobiliary and pancreatic Department of the First hospital of Jilin University from June 2019 to January 2020 were enrolled.According to the degree of esophageal varices detected by gastroscopy,these cirrhotic patients were divided into non-EV group(G0)? mild EV group(G1)? moderate EV group(G2)and severe EV group(G3);according to the history of bleeding,these patients were divided into bleeding group(EVB)and non-bleeding group(NEVB).Portal vein diameter(PVD),portal vein velocity(PVV),splenic vein diameter(SVD),splenic vein velocity(SVV),splenic artery pulsatility index(SAPI),splenic artery resistance index(SARI),splenic diameter,splenic thickness,and the thickness of esophageal wall were measured by Gray-scale and Doppler ultrasound.The splenic index(SI= Splenic diameter×splenic thickness)and the splenoportal index(SPI=SI/PVV)were calculated.The basic information and clinical data of patients were collected.IBM SPSS statistics 25 was used for data analysis.Spearman correlation was used to analyze the correlation between the parameters and the severity of esophageal varices.Chi-square test was used to compare the inter group rate of qualitative data.For quantitative data,Independent-sample t test or Mann Whitney U test was used for comparison between two groups,one-way ANOVA or Kruskal Wallis H test was used for comparison between multiple groups,and Marginal Homogeneity Test was used for comparison between two paired grade data.The index of single factor analysis(P<0.01)was included in multivariate Logistic regression analysis,and according to the regression coefficient,the joint diagnosis model established.ROC curve was used to evaluate the diagnostic value of each index to EV and EVB.Results1.There was no significant difference in age,gender and etiology between different esophageal varices groups(P>0.05).There was no significant difference in age,gender and etiology between bleeding group and non-bleeding group(P>0.05).2.Spearman correlation analysis showed that esophageal wall thickness,SI,PVV,SVD and PVD were correlated with the severity of esophageal varices(P<0.01).The correlation coefficients were 0.866,0.619,-0.444,0.405 and 0.310,respectively.There was no significant correlation between SAPI,SARI,SVV and the severity of esophageal varices(P>0.05).3.There was significant difference in esophageal wall thickness between EV groups(P<0.05),5.3 mm,6.25 mm and 7.15 mm were used as the cut-off values for the classification of non-EV and mild EV,mild EV and moderate EV,moderate EV and severe EV respectively.There was no significant difference between the results of ultrasonography and gastroscope(P>0.05).4.Univariate analysis showed that the differences of PVD,SVD,SI and PVV between the moderate-severe group and the non-mild group were statistically significant(P<0.01);multivariate analysis showed that PVV,SI and SAPI were independent predictors of moderate-severe esophageal varices,and a joint diagnosis model(SI+PVV+SAPI)was established.The area under the curve of PVV,SI,SAPI,SPI and SI+PVV+SAPI was 0.756,0.817,0.621,0.897 and 0.906,respectively.SPI and SI+PVV+SAPI had the highest diagnostic value,when using 5.31 and-4.85 as cut-off points,the diagnostic accuracy was 81.9% and 83.1% respectively.5.Univariate analysis showed that esophageal wall thickness,SVD,SI,the incidence of ascites in EVB group were significantly higher than that in NEVB group(P<0.01).Multivariate analysis showed that the enlargement of splenic vein diameter and esophageal wall thickness were independent risk factors for EVB.The area under the ROC curve of SVD and esophageal wall thickness was 0.797,0.809 respectively.When using 10.05 mm and 6.55 mm as cut-off points,the diagnostic accuracy was 73.4% and 77.1% respectively.Conclusions1.The thickness of esophageal wall can be used to evaluate the severity of esophageal varices.The best cut-off values for the classification of non-EV and mild EV,mild and moderate EV,moderate and severe EV are 5.3 mm,6.25 mm and 7.15 mm,respectively.The increase of esophageal wall thickness was also an independent risk factor for esophageal variceal bleeding.The sensitivity and specificity of esophageal wall thickness?6.55 mm were 83.3% and 70.7%,respectively.2.In the Doppler index,the combined diagnosis model(SI+PVV+SAPI)and the splenoportal index(SPI)can be used as a good index for the diagnosis of moderate to severe esophageal varices.The sensitivity and specificity of SI+PVV+SAPI?-4.85 are 78.4% and 90.6% respectively;the sensitivity and specificity of SPI?5.31 are 78.4% and 87.5% respectively.The widening of splenic vein diameter(SVD)is an independent risk factor for esophageal variceal bleeding.The sensitivity and specificity of SVD?10.05 mm are 73.8% and 73.2%,respectively.