Risk Factors For Formation Of Portal Hypertensive Gastropathy In Patients With Liver Cirrhosis And Effect Of Gastroesophageal Variceal Ligation On It

Objective: To evaluate the incidence of PHG in patients with liver cirrhosis,to analyze the risk factors of PHG,and to explore the effect of first EVL on PHG in patients with liver cirrhosis,so as to find,diagnose,prevent PHG early.Methods: A retrospective analysis of 325 patients with cirrhosis hospitalized in the Department of Gastroenterology of the second hospital of Hebei Medical University from 1 January 2018 to 31 December 2020 was performed.All patients agreed to receive endoscopy.General clinical data,degree of esophageal and gastric varices,endoscopic characteristics of PHG were recorded.All patients were divided into PHG group and non-PHG group after endoscopic examination.IBM SPSS 25 software was used to perform Student’s t test,chi-square test or rank sum test for all indicators of patients in the two groups.Binary Logistic multivariate regression analysis was conducted for significant indicators.If P<0.05 was considered an independent risk factor.According to the Baveno consensus,Patients with gstroesophageal varices under EVL were selected.Then the degree of PHG before and after first ligation was recorded and compared.Results:1.A total of 325 patients with cirrhosis were included,including 207 males and 118 females,with a median age of 54.00(47.00-61.00)years.There were 284 patients diagnosed with PHG after endoscopic examination,and the incidence of PHG was 87.4%.2.The significance test showed that there were significant differences in gender(P=0.034),hemoglobin(P=0.009),platelet count(P=0.000),prothrombin time(P=0.012)and albumin(P=0.009)between the two groups.The severity of PHG in patients with different Child-Pugh grades of liver function was statistically different(P=0.018).The degree of EV(Spearmamn correlation coefficient: 0.419,P<0.001),the degree of GV(Spearmamn correlation coefficient: 0.343,P<0.001)and the degree of ascites(Spearmamn correlation coefficient: 0.151,P=0.007)were positively correlated with the incidence and severity of PHG.3.Binary Logistic multivariate regression analysis showed that albumin,the degree of EV,the degree of GV were independent risk factors of PHG.The prediction value of the degree of EV and GV on PHG was analyzed by ROC.The AUC under ROC was 0.811 and 0.740,the critical value was 1.5and 1.5,the sensitivity was 78.5% and 55.3%,the specificity was 68.3% and97.2%,respectively.4.The Baveno score of PHG was significantly higher after EVL than before EVL(P<0.001).After EVL,the number of patients without PHG decreased from 6 to 0,the number of patients with mild PHG decreased from56 to 41,and the number of patients with severe PHG increased from 9 to 30(P<0.001).Conclusions:1.The incidence of PHG in liver cirrhosis in this study is 87.4%.2.The occurrence of PHG is related to gender,hemoglobin,platelet count,prothrombin time,albumin and Child-Pugh grade of liver function.The incidence and severity of PHG increase with the degree of EV,GV and ascites.3.Albumin,the degree of EV and GV are independent risk factors of PHG.The degree of EV and GV can be used to predict PHG.4.The EVL can aggravate the occurrence and severity of PHG.We should pay attention to the presence and severity of PHG after EVL to prevent bleeding.