Chinese Hepatolgy ›› 2021, Vol. 26 ›› Issue (2): 147-150.

• Liver Fibrosis & Cirrhosis • Previous Articles     Next Articles

The clinical significance of liver reserve function for evaluating the severity of esophageal and gastric varices in patients with liver cirrhosis

WANG Yu1,3,5, DONG Chun-ling3, YU Yi-li3, GU Hong-tu1,3, ZHAO Chang-qing1,3, MU Yong-ping1,3, YUAN Ji-li1,3, LV Jing1,3, TAO Yan-yan1,2,3, LIU Cheng-hai1,2,3,4   

  1. 1. Institute of Liver Diseases, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China;
    2. Shanghai Key Laboratory of Traditional Chinese Medicine, Shanghai 201203, China;
    3. Department of Hepatology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China;
    4. Shanghai Innovation Center of TCM Health Service, Shanghai 201203, China;
    5. Department of Gastroenterology, Baoshan, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201999, China
  • Received:2020-03-15 Online:2021-02-28 Published:2021-03-28
  • Contact: LIU Cheng-hai,Email:chenghailiu@hotmail.com;LV Jing,Email:ljliver@163.com

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Abstract: Objective To explore the clinical value of liver reserve function and portal vein diameter (PVD) in predicting the severity of esophageal gastric varices (EGV) in patients with liver cirrhosis.Methods The clinical data of 151 patients with liver cirrhosis were retrospectively analyzed. All patients underwent gastroendoscopic examination. They were then divided into no or mild esophageal varices group, and moderate or severe esophageal varices group referred to the "Trial Scheme for Endoscopic Diagnosis and Treatment of Gastrointestinal Varicose Veins and Bleeding (2009)", "Baveno Ⅵ Consensus (2015)", "Central Hypertension Esophageal Varicose Hemorrhage Guidelines for Prevention and Treatment (2015). The relationship between the degree of EGV and Indocyanine green elimination rate (ICG-K) and Indocyanine green retention test (ICG-R15) was analyzed. Measurement data that conformed to the normal distribution were expressed as mean±standard deviation ($\bar{x}$±s), and the comparison between two groups was performed with T test or analysis of variance. Median and interquartile intervals were used for measurement data that didn’t meet the normal distribution [M (P25 ~ P75)], and the comparison between two groups was performed with the rank sum test. The comparison of count data between groups was performed using the χ2 test, and those who did not meet the χ2 test conditions used Fisher's exact test. Factor analysis was performed using a binary logistic regression model, and OR values of risk factors and 95% of OR values were calculated. Results Among the indexes related to liver reserve function with no or mild EGV, ICG-R15, PVD, Chid-Pugh-score, model for end-stage liver disease (MELD) score, total bilirubin (Tbil), prothrombin time (PT), and international normalized ratio (INR) were lower than those in the moderate or severe EGV group. ICG-K value, The EHBF, Alb, PLT, and APRI scores of no or mild EGV group were greater than those of moderate or severe EGV group, and the difference between the two groups was statistically significant (P<0.05). Among them, ICG-K, ICG-R15, PVD, Chid-Pugh-scores are independent risk factors for moderate or severe esophageal and gastric varicose veins and the EGV severity is positively correlated (OR values ??are 0.003, 1.111, 1.591, 4.669, P values (Both <0.05). The AUC for predicting no or mild EGV and moderate or severe EGV is 0.116, 0.877, 0.773, 0.746, respectively. Further analysis of ICG-R15's diagnostic cutoff value for the diagnosis of moderate or severe EGV is 19.650%, and its sensitivity The specificities were 0.729 and 0.955, respectively.Conclusion Liver reserve function, namely ICG-K, ICG-R15, Chid-Pugh score and PVD are independent risk factors for moderate or severe EGV. ICG-R15 has good diagnostic value for predicting the grade of moderate or severe EGV. It can therefore be used as a supplementary reference for further invasive gastroscopic evaluation.

Key words: Liver reserve function, Esophageal gastric varices, Liver cirrhosis