肝静脉压力梯度预测内镜下食管静脉曲张套扎术后早期再出血的临床应用  

Clinical application of hepatic venous pressure gradient to predict early bleeding after esophageal variceal ligation

作　　者：刘丙菊 吴利春 王广川[1] 冯华[1] 胡锦华[1] 崔屹[1] 张春清[1] 

机构地区：[1]山东大学附属省立医院消化内科,济南250021 [2]北京天坛医院重症监护科

出　　处：《中华肝脏病杂志》2015年第1期50-54,共5页Chinese Journal of Hepatology

摘　　要：目的 探讨肝静脉压力梯度（HVPG）预测内镜下食管静脉曲张套扎术（EVL）后早期再出血的应用价值.方法 研究有肝硬化食管静脉曲张出血史、EVL前行HVPG测定患者105例.收集其住院期间HVPG值、内镜下表现及EVL术后2周内是否出血及其他严重并发症等.应用x^2检验、秩和检验、logiStic回归模型的假设检验及受试者工作特征曲线（ROC）分析进行统计学处理. 结果 经统计学分析,只有HVPG是EVL术后早期再出血的独立危险因素.对HVPG关于EVL术后早期再出血行ROC分析,得出曲线下面积（AUC）为0.866,当HVPG≥16 mmHg时,AUC为0.838,有一定准确性,其敏感性为90.9％,特异性为76.6％.结论 HVPG是影响EVL术后早期再出血的独立危险因素.HVPG≥16 mmHg作为预测EVL术后早期再出血的阈值,具有一定准确性、敏感性及特异性.Objective To investigate the predictive value of hepatic venous pressure gradient （HVPG） for early bleeding after esophageal variceal ligation （EVL） by analyzing the differences in HVPG in patients with and without post-EVL bleeding.Methods The medical records of patients who had been diagnosed with cirrhosis and esophageal varices and who had pre-EVL HVPG measurement data were surveyed.The study population included 105 patients from October 2010 to March 2014.Data of HVPG value,previous treatment history,endoscopic manifestation,and whether bleeding and serious complications occurred within 2 weeks after the ligation procedure were investigated as independent risk factors.Statistical methods included the chi-square test and Wilcoxon test,logistic regression modeling and receiver operating characteristic （ROC） analysis using the SPSS software version 16.Results Only HVPG value was identified as an independent risk factor of early bleeding after EVL.According to the ROC analysis,the area under the curve （AUC） of HVPG for early bleeding after EVL was 0.866; when HVPG was ≥ 16 mmHg,AUC was 0.838.The sensitivity was 90.9％ and the specificity was 76.4％.Conclusion HVPG is an independent factor of early bleeding after EVL and when HVPG cut-off value of ≥ 16 mmHg is used the predictive ability has certain accuracy and high sensitivity and specificity.

关 键 词：肝硬化 高血压 门静脉 静脉压 肝 食管和胃静脉曲张 手术后出血 

分 类 号：R575.2[医药卫生—消化系统]