Kumar Vivek, Kansal Divyam, Chaudhary Shyam Chand, Gupta K K, Usman Kauser, Atam Virendra, Sawlani K K, Lamba Mahak, Kumar Ajay, Reddy Himanshu
Internal Medicine, King George's Medical University, Lucknow, IND.
Internal Medicine, King George's Medical University, Lucknow, India., Lucknow, IND.
Cureus. 2023 May 31;15(5):e39792. doi: 10.7759/cureus.39792. eCollection 2023 May.
Background Portal hypertension leads to the formation of portosystemic collateral veins, of which esophageal varices (EV) are the most severe complications and have the greatest clinical impact. The possibility of identifying cirrhotic patients with varices by non-invasive tests is appealing, as they can lead to reduced healthcare costs and can be done in resource-limited settings. In this study, we investigated ammonia as a potential non-invasive predictor of EV. Methods This was a single-center cross-sectional observational study that was done at a tertiary health care hospital in north India. It included 97 chronic liver disease patients irrespective of etiology after excluding patients with portal vein thrombosis and hepatocellular carcinoma to participate in endoscopic screening for the presence of EV and correlate it with various non-invasive markers like serum ammonia levels, thrombocytopenia and aspartate aminotransferase to platelet ratio index (APRI ). On the basis of endoscopy, enrolled patients were divided into two groups, i.e., group A consisting of large varices (grade III and grade IV) and group B consisting of patients with low-grade varices and no varices (grade II, grade I, and no varices). Results This study included 97 patients, out of which 81 patients have varices on endoscopy, and mean serum ammonia levels were found to be significantly higher in cases with varices (135 ±69.70 ) vs. those without varices (94±43) (p value=0.026). Further, on comparing serum ammonia values between patients with large varices (Grade III/IV) (Group A) with a mean value of 176 ± 83 vs. Grade I/II/No varices (Group B) with a mean value of 107±47, which were significantly higher in Group A patients (<0.001). In our study, we also found a correlation between blood urea level as a non-invasive predictor of varices, but no statistically significant relation was found between thrombocytopenia and APRI. Conclusion This study found that serum ammonia can be used as a useful marker for the prediction of EV and can also be used to determine the severity of varices. Apart from ammonia, serum urea levels can also prove to be a good non-invasive marker for the prediction of varices although further multicentric studies are warranted to reach this conclusion.
背景 门静脉高压会导致门体侧支静脉形成，其中食管静脉曲张（EV）是最严重的并发症，对临床影响最大。通过非侵入性检查来识别患有静脉曲张的肝硬化患者很有吸引力，因为这可以降低医疗成本，并且可以在资源有限的环境中进行。在本研究中，我们研究了氨作为食管静脉曲张的一种潜在非侵入性预测指标。方法 这是一项在印度北部一家三级医疗保健医院进行的单中心横断面观察性研究。研究纳入了97例慢性肝病患者，排除门静脉血栓形成和肝细胞癌患者，不论病因如何，参与内镜检查以筛查食管静脉曲张的存在，并将其与各种非侵入性指标如血清氨水平、血小板减少症以及天冬氨酸转氨酶与血小板比值指数（APRI）进行关联。根据内镜检查结果，将入选患者分为两组，即A组为大静脉曲张（III级和IV级）患者，B组为轻度静脉曲张和无静脉曲张患者（II级、I级和无静脉曲张）。结果 本研究共纳入97例患者，其中81例患者在内镜检查中发现有静脉曲张，有静脉曲张患者的平均血清氨水平（135±69.70）显著高于无静脉曲张患者（94±43）（p值=0.026）。此外，比较大静脉曲张（III/IV级）患者（A组）的血清氨值，平均值为176±83，与轻度/无静脉曲张（I/II级/无静脉曲张）患者（B组）的血清氨值，平均值为107±47，A组患者的血清氨值显著更高（<0.001）。在我们的研究中，我们还发现血尿素水平作为静脉曲张的非侵入性预测指标存在相关性，但血小板减少症与APRI之间未发现统计学上的显著关系。结论 本研究发现血清氨可作为预测食管静脉曲张的有用标志物，也可用于确定静脉曲张的严重程度。除了氨之外，血清尿素水平也可能被证明是预测静脉曲张的良好非侵入性标志物，不过需要进一步的多中心研究来得出这一结论。
