Hepato-gastroenterology and Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo.
Hepatology Department, National Liver Institute, Menofia University.
Eur J Gastroenterol Hepatol. 2021 Feb 1;32(2):230-236. doi: 10.1097/MEG.0000000000001715.
There is a growing need for identification of non-endoscopic, non-invasive methods that can accurately predict esophageal varices (EV). Previous studies found an inconclusive correlation between blood ammonia level and the presence and size of EV.
We aimed at assessing the value of serum ammonia as a non-invasive method for early prediction of EV.
The study included 204 patients with HCV-related cirrhosis. The selected patients were categorized into two groups: patients with EV and those without, also patients with no or small EV and with large EV group. All patients underwent a complete biochemical workup, ultrasound and upper GI endoscopy. Child-Pugh class, Model of End-Stage Liver Disease (MELD) score and platelet count/splenic diameter ratio, and serum ammonia level.
There was a statistical difference between the two groups of patients regarding the following parameters: serum ammonia, international normalized ratio, portal vein diameter, spleen diameter, Child-Pugh class, MELD score, platelet count/splenic diameter ratio, aspartate aminotransferase-to-platelet ratio index, alanine aminotransferase-to-aspartate aminotransferase ratio, Forns index, FIB-4 and King's score. Serum ammonia could predict the presence of EV using a cutoff value of 82 (µmol/L) with a sensitivity of 92.3%, specificity 92%. In addition, a cutoff of 95.5 (µmol/L) could predict large EV with a sensitivity of 92.7% and a specificity of 92.3%. Serum Ammonia in cirrhosis with large EV was 143 ± 39 µmol/L and in cirrhosis with small/without EV was 80.7 ± 9.7 µmol/L (P < 0.0001). Platelet/spleen ratio was 555.9 ± 187.3 in cirrhosis with EV and 694.4 ± 74.2 in cirrhosis without EV (P < 0.0001). Platelet/spleen ratio was 407.7 ± 107.1 in cirrhosis with large EV and 690.4 ± 103.7 in cirrhosis with small/without EV (P < 0.0001).
Serum ammonia can accurately predict the presence and the size of EV in patients with liver cirrhosis with high sensitivity and specificity.
对于能够准确预测食管静脉曲张 (EV) 的非内镜、非侵入性方法的需求日益增长。先前的研究发现血液氨水平与 EV 的存在和大小之间存在不确定的相关性。
我们旨在评估血清氨作为预测 EV 的早期非侵入性方法的价值。
该研究纳入了 204 例丙型肝炎相关肝硬化患者。将所选患者分为两组：有 EV 组和无 EV 组，以及无 EV 或小 EV 组和大 EV 组。所有患者均接受了全面的生化检查、超声和上消化道内镜检查。Child-Pugh 分级、终末期肝病模型 (MELD) 评分和血小板计数/脾径比，以及血清氨水平。
两组患者在以下参数方面存在统计学差异：血清氨、国际标准化比值、门静脉直径、脾直径、Child-Pugh 分级、MELD 评分、血小板计数/脾径比、天冬氨酸转氨酶/血小板比值指数、丙氨酸转氨酶/天冬氨酸转氨酶比值、Forns 指数、FIB-4 和 King 评分。血清氨可通过 82（µmol/L）的截断值预测 EV 的存在，其灵敏度为 92.3%，特异性为 92%。此外，截断值为 95.5（µmol/L）可预测大 EV，其灵敏度为 92.7%，特异性为 92.3%。肝硬化伴大 EV 患者的血清氨为 143±39µmol/L，肝硬化伴小/无 EV 患者的血清氨为 80.7±9.7µmol/L（P<0.0001）。有 EV 的肝硬化患者的血小板/脾比值为 555.9±187.3，无 EV 的肝硬化患者的血小板/脾比值为 694.4±74.2（P<0.0001）。有大 EV 的肝硬化患者的血小板/脾比值为 407.7±107.1，有小/无 EV 的肝硬化患者的血小板/脾比值为 690.4±103.7（P<0.0001）。
血清氨可准确预测肝硬化患者 EV 的存在和大小，具有较高的灵敏度和特异性。
