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Abstract：
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.
摘要：
背景门静脉高压导致门体侧支静脉的形成,其中食管静脉曲张（EV）是最严重的并发症，具有最大的临床影响。通过非侵入性测试识别患有静脉曲张的肝硬化患者的可能性很有吸引力，因为它们可以降低医疗保健成本，并且可以在资源有限的环境中完成。在这项研究中,我们调查了氨作为EV的潜在非侵入性预测因子。方法这是一项单中心横断面观察研究，在印度北部的一家三级保健医院进行。它包括97例慢性肝病患者，在排除门静脉血栓形成和肝细胞癌患者后，无论病因如何，参与内镜筛查是否存在EV，并将其与各种非侵入性标志物如血清氨水平相关联。血小板减少症和天冬氨酸转氨酶与血小板比值指数（APRI）。在内窥镜检查的基础上，将入选的患者分为两组,即，A组由大静脉曲张（III级和IV级）组成，B组由低级别静脉曲张且无静脉曲张（II级，I级,并且没有静脉曲张）。结果本研究共纳入97例患者,其中81例患者在内窥镜检查中出现静脉曲张，静脉曲张患者的平均血清氨水平（135±69.70）明显高于无静脉曲张者(94±43)(p值=0.026)。Further,比较大静脉曲张患者（III/IV级）（A组）的血清氨值，平均值为176±83I级/II级/无静脉曲张（B组），平均值为107±47，在A组患者中明显更高（<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之间存在相关性，但是在血小板减少症和APRI之间没有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EV的有用标志物，也可用于判断静脉曲张的严重程度。除了氨,血清尿素水平也可以被证明是预测静脉曲张的良好非侵入性标志物，尽管需要进一步的多中心研究才能得出这一结论。
