Serum IgM , IgG, TBIL, prothrombin activity (PTA) combined transient elastography in the diagnosis of cirrhosis with esophageal and gastric varices
serum markers, transient elastography in cirrhosis
Abstract
Objective: To explore the application and clinical value of Serum IgM , IgG, TBIL, prothrombin activity (PTA) combined transient elastography (TE) in diagnosing and assessing the degree of liver cirrhosis combined with esophageal and gastric varices (EGV).
Methods: We chose 136 patients with cirrhosis and EGV admitted to the Liver Disease Department of our hospital from December 2022 to December 2024. The patients were divided into mild EGV (n=71), moderate EGV (n=40), and severe EGV (n=25) based on the gastroscopic results, and another 50 cases of healthy physical examination at the same period were admitted into the control group. All cases underwent liver TE, biochemical parameters, and immune parameters examination to observe the diagnostic efficacy of liver TE in cirrhosis combined with EGV and the degree of varices.
Results: The differences in TBIL, ALT, AST, PTA, and other biochemical parameters between all of groups were not statistically significant (P > 0.05). The differences were not statistically significant for the four groups of IgM, IgG, and other immune indices (P > 0.05). There was no significant difference in blood flow among these groups (P > 0.05). The interior diameter (ID) of the portal vein, blood flow velocity, and liver stiffness values were significant (P < 0.05). Portal vein ID, blood velocity, and liver stiffness values showed well diagnostic efficacy in cirrhosis with EGV, and liver stiffness values were the best in evaluating cirrhosis with EGV (P < 0.05). Liver stiffness values were more effective in assessing the degree of varices in cirrhosis combined with EGV and the best in diagnosing cirrhosis combined with severe EGV (P < 0.05).
Conclusion: The application of liver TE has a high value in diagnosing cirrhosis combined with EGV and their degree of varices, especially in identifying severe curves, which has good clinical value.
References
[2]Jin Z, Chenghao Y, Cheng P. Anticancer Effect of Tanshinones on Female Breast Cancer and Gynecological Cancer. Front Pharmacol. 2022 Jan 25;12:824531. doi: 10.3389/fphar.2021.824531. PMID: 35145409.
[3]Nett A, Binmoeller KF. Endoscopic Management of Portal Hypertension-related Bleeding. Gastrointest Endosc Clin N Am. 2019 Apr;29(2):321-337. doi: 10.1016/j.giec.2018.12.006. PMID: 30846156.
[4]Zuckerman MJ, Elhanafi S, Mendoza Ladd A. Endoscopic Treatment of Esophageal Varices. Clin Liver Dis. 2022 Feb;26(1):21-37. doi: 10.1016/j.cld.2021.08.003. Epub 2021 Sep 25. PMID: 34802661.
[5]Midia M, Odedra D, Shuster A, Midia R, Muir J. Predictors of bleeding complications following percutaneous image-guided liver biopsy: a scoping review. Diagn Interv Radiol. 2019 Jan;25(1):71-80. doi: 10.5152/dir.2018.17525. PMID: 30644369.
[6]Bilreiro C, Noruegas MJ, Gonçalves I, Moreira Â. Ultrasound-guided Liver Biopsies in Children: A Single-center Experience and Risk Factors for Minor Bleeding. J Pediatr Gastroenterol Nutr. 2017 Aug;65(2):137-140. doi: 10.1097/MPG.0000000000001601. PMID: 28394846.
[7]Mangas-Sanjuan C, Martínez-Moreno B, Bozhychko M, Compañy L, Martinez J, Ruiz F, Casellas JA, Aparicio JR. Over-the-scope clip for acute esophageal variceal bleeding. Dig Endosc. 2019 Nov;31(6):712-716. doi: 10.1111/den.13493. Epub 2019 Aug 20. PMID: 31330068.
[8]Abe H, Midorikawa Y, Matsumoto N, Moriyama M, Shibutani K, Okada M, Udagawa S, Tsuji S, Takayama T. Prediction of esophageal varices by liver and spleen MR elastography. Eur Radiol. 2019 Dec;29(12):6611-6619. doi: 10.1007/s00330-019-06230-8. Epub 2019 Apr 30. PMID: 31041563.
[9]Mnif L, Hachicha S, Abid F, Gdoura H, Chtourou L, Amouri A, Boudabbous M, Tahri N. Role of splenic and hepatic stiffness in predicting esophageal varices. Tunis Med. 2021 Mai;99(5):544-551. English. PMID: 35244904.
[10]Malek MS, Hoque MN, Azam MG, Kabir MA, Islam MS, Mamoon MA, Ahmed S, Siddiqui NI. Prediction of Esophageal Varices in Chronic Liver Disease by Liver Stiffness-Spleen Size-to-Plalelet Ratio Risk Score. Mymensingh Med J. 2021 Jan;30(1):115-122. PMID: 33397861.
[11]Korean Association for the Study of the Liver (KASL). KASL clinical practice guidelines for liver cirrhosis: Varices, hepatic encephalopathy, and related complications. Clin Mol Hepatol. 2020 Apr;26(2):83-127. doi: 10.3350/cmh.2019.0010n. Epub 2020 Jan 10. PMID: 31918536
[12]Northup PG, Garcia-Pagan JC, Garcia-Tsao G, Intagliata NM, Superina RA, Roberts LN, Lisman T, Valla DC. Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Jan;73(1):366-413. doi: 10.1002/hep.31646. Epub 2021 Jan 20. PMID: 33219529.
[13]Hong G, Su C, Huang Z, Zhuang Q, Wei C, Deng H, Chen W, Peng H. Electrochemiluminescence Immunoassay Platform with Immunoglobulin G-Encapsulated Gold Nanoclusters as a "Two-In-One" Probe. Anal Chem. 2021 Sep 28;93(38):13022-13028. doi: 10.1021/acs.analchem.1c02850. Epub 2021 Sep 15. PMID: 34523333.
[14]Lesmana CRA, Raharjo M, Gani RA. Managing liver cirrhotic complications: Overview of esophageal and gastric varices. Clin Mol Hepatol. 2020 Oct;26(4):444-460. doi: 10.3350/cmh.2020.0022. Epub 2020 Oct 1. PMID: 33053928.
[15]de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty. Baveno VII - Renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959-974. doi: 10.1016/j.jhep.2021.12.022. Epub 2021 Dec 30. Erratum in: J Hepatol. 2022 Apr 14;: PMID: 35120736.
[16]Chapin CA, Bass LM. Cirrhosis and Portal Hypertension in the Pediatric Population. Clin Liver Dis. 2018 Nov;22(4):735-752. doi: 10.1016/j.cld.2018.06.007. Epub 2018 Aug 22. PMID: 30266160.
[17]Gunarathne LS, Rajapaksha H, Shackel N, Angus PW, Herath CB. Cirrhotic portal hypertension: From pathophysiology to novel therapeutics. World J Gastroenterol. 2020 Oct 28;26(40):6111-6140. doi: 10.3748/wjg.v26.i40.6111. PMID: 33177789.
[18]Sack JS, Li M, Zucker SD. Bleeding Outcomes Following Transesophageal Echocardiography in Patients With Cirrhosis and Esophageal Varices. Hepatol Commun. 2020 Nov 21;5(2):283-292. doi: 10.1002/hep4.1635. PMID: 33553975.
[19]Garbuzenko DV, Arefyev NO. Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: An update and review of the literature. J Evid Based Med. 2020 Nov;13(4):313-324. doi: 10.1111/jebm.12407. Epub 2020 Oct 9. PMID: 33037792.
[20]de Franchis R, Krag A. Ruling out esophageal varices in NAFLD cirrhosis: Can we do without endoscopy? J Hepatol. 2018 Oct;69(4):769-771. doi: 10.1016/j.jhep.2018.06.013. Epub 2018 Jul 4. PMID: 30227915.
[21]Kolb JM, Wani S, Soetikno R, Edmundowicz SA, Hammad H. Endoscopic submucosal dissection for early esophageal and gastric neoplasia in decompensated cirrhosis with varices. Endoscopy. 2021 Apr;53(4):E128-E129. doi: 10.1055/a-1216-0148. Epub 2020 Aug 5. PMID: 32757192.
[22]Wong GL, Liang LY, Kwok R, Hui AJ, Tse YK, Chan HL, Wong VW. Low Risk of Variceal Bleeding in Patients With Cirrhosis After Variceal Screening Stratified by Liver/Spleen Stiffness. Hepatology. 2019 Sep;70(3):971-981. doi: 10.1002/hep.30522. Epub 2019 Mar 15. PMID: 30681726.
[23]de Franchis R. The Changing Scenario of Screening and Surveillance of Esophageal Varices. Gastroenterology. 2019 Mar;156(4):864-866. doi: 10.1053/j.gastro.2019.02.011. Epub 2019 Feb 15. PMID: 30776346.
[24]Calvaruso V, Cacciola I, Licata A, Madonia S, Benigno R, Petta S, Bronte F, Conte E, Malizia G, Bertino G, Distefano M, Montineri A, Digiacomo A, Alaimo G, Cacopardo B, Davì A, Guarneri L, Scalisi I, Colletti P, Cartabellotta F, Portelli V, Prestileo T, Averna A, Iacobello C, Mondello L, Scifo G, Russello M, Squadrito G, Raimondo G, Cammà C, Craxì A, Di Marco V; RESIST-HCV (Rete Sicilia Selezione Terapia–HCV). Is Transient Elastography Needed for Noninvasive Assessment of High-Risk Varices? The REAL Experience. Am J Gastroenterol. 2019 Aug;114(8):1275-1282. doi: 10.14309/ajg.0000000000000266. PMID: 31135449.
[25]Sharma S, Agarwal S, Gunjan D, Kaushal K, Anand A, Saraya A. Deciding Among Noninvasive Tools for Predicting Varices Needing Treatment in Chronic Liver Disease: An Analysis of Asian Cohort. Am J Gastroenterol. 2020 Oct;115(10):1650-1656. doi: 10.14309/ajg.0000000000000722. PMID: 32516202.
[26]Ferreira-Silva J, Gaspar R, Liberal R, Cardoso H, Macedo G. Transient splenic elastography predicts high-risk esophageal varices in patients with non-cirrhotic portal hypertension. Scand J Gastroenterol. 2021 Dec;56(12):1462-1466. doi: 10.1080/00365521.2021.1968485. Epub 2021 Aug 24. PMID: 34428123.
[27]Uzlová N, Mejzlíková N, Fraňková S, Libicherová P, Nosek D, Rychlík I. Transient elastography - role in the assessment of the liver disease development. Vnitr Lek. 2018 Fall;64(10):916-922. English. PMID: 30590937.
[28]Pár G, Trosits A, Pakodi F, Szabó I, Czimmer J, Illés A, Gódi S, Bajor J, Sarlós P, Kenyeres P, Miseta A, Vincze A, Pár A. Tranziens elasztográfia mint a nyelőcső-varicositas prediktora májcirrhosisban szenvedő betegekben [Transient elastography as a predictor of oesophageal varices in patients with liver cirrhosis]. Orv Hetil. 2014 Feb 16;155(7):270-6. Hungarian. doi: 10.1556/OH.2014.29824. PMID: 24509356.
[29]Zhang X, Wong GL, Wong VW. Application of transient elastography in nonalcoholic fatty liver disease. Clin Mol Hepatol. 2020 Apr;26(2):128-141. doi: 10.3350/cmh.2019.0001n. Epub 2019 Nov 8. PMID: 31696690.
[30]Zhu Q, Wang W, Zhao J, Al-Asbahi AAM, Huang Y, Du F, Zhou J, Song Y, Xu K, Ye J, Yang L. Transient Elastography Identifies the Risk of Esophageal Varices and Bleeding in Patients With Hepatitis B Virus-Related Liver Cirrhosis. Ultrasound Q. 2018 Sep;34(3):141-147. doi: 10.1097/RUQ.0000000000000373. PMID: 30020268.
[31]Petrisor A, Stanescu AMA, Papacocea IR, Panaitescu E, Peagu R, Moldoveanu AC, Fierbinteanu-Braticevici C. Non-invasive laboratory, imaging and elastography markers in predicting varices with high risk of bleeding in cirrhotic patients. Rom J Intern Med. 2021 May 8;59(2):194-200. doi: 10.2478/rjim-2021-0001. PMID: 33544557.
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