建立肝硬化食管胃底静脉曲张破裂的多因素出血概率风险预测模型  

Risk prediction model building for miltivariate factors of gastroesophageal variceal hemorrhage in patients with cirrhosis

作　　者：王群茹 周德江[1] 曾维政[1] 牟东[1] 张勇[1] WANG Qunru;ZHOU Dejian;ZENG Weizheng;MOU Dong;ZHANG Yong(Department of Gastroenterology, General Hospital of Chengdu Military Region, Chengdu 610038, China)

机构地区：[1]成都军区总医院消化内科,四川成都610038

出　　处：《西部医学》2018年第7期993-997,共5页Medical Journal of West China

基　　金：四川省卫计委资助项目(16PJ010)

摘　　要：目的通过综合分析肝硬化伴食管胃底静脉曲张破裂患者发生出血的危险因素,建立多因素出血概率风险预测模型,实现对出血的早期预测,尽早对患者进行出血风险干预,减少肝硬化伴食管胃底静脉曲张患者发生出血风险。方法纳入2014年3月~2016年3月在我院进行治疗的96例肝硬化患者,将发生食管胃底静脉曲张破裂出血的55例患者设为研究组(出血组),将未发生出血的41例患者设为对照组(非出血组)。对两组患者的基础特征指标、生化指标、影像指标等进行统计分析,筛选影响出血发生的危险因素,建立出血概率风险预测模型。结果两组患者基线指标比较差异无统计学意义(P>0.05);单因素分析显示,血清白蛋白、血小板、凝血酶原时间、门静脉内径、脾静脉主干内径、食管静脉曲张程度、消化性溃疡、红色征对出血的影响差异均有统计学意义(P<0.05);多因素Logistics回归分析显示,红色征、食管静脉曲张程度、门静脉内径、凝血酶原时间等4项为危险性因素,血清白蛋白、血小板为保护性因素,对出血的影响差异均有统计学意义(P<0.05);纳入多因素显著指标,建立多因素出血概率风险预测模型,模型对回顾性病例总准确率为84.375%,灵敏度和特异性俱佳。结论血清白蛋白及血小板下降、胃镜检查出现红色征或食管静脉曲张程度重、门静脉内径变宽的肝硬化患者发生食管胃底静脉曲张破裂出血的风险加大,应对患者给予早期临床干预;本研究基于6项独立影响因素建立的多因素出血概率风险预测模型具有较好的准确性,有待进一步验证和模型调优。Objective To build a multivariate factors risk prediction model of gastroesophageal variceal hemorrhage in patients with cirrhosis through analysis of hemorrhage risk factors,so as to make hemorrhage risk intervention to patients as early as possible,and reduce the risk of variceal bleeding in patients with cirrhosis.Methods In accordance with the inclusion and exclusion criteria designed based on researches,96 patients with cirrhosis treated in our hospital from March 2014 to March 2016 were taken as research samples.55 patients suffering from gastroesophageal variceal hemorrhage were included into the research group（hemorrhage group）.41 patients suffering from no hemorrhage were included into the control group（non-hemorrhage group）.Survey and analysis were made on the basic characteristic indexes,biochemical indexes and image indexes of the two groups to screen out the risk factors of hemorrhage.Results There was no difference in baseline indicators between the two groups（P〉0.05）.The serum albumin,platelet,prothrombin time,portal venous diameter,splenic vein trunk diameter,size of esophageal varices,peptic ulcer,and red color sign were related to hemorrhage（P〈0.05）.Logistic regression analysis showed that red color sign,size of esophageal varices,portal venous diamete and prothrombin time were risk factors of hemorrhage（P〈0.05）.The serum albumin and platelet were protective factors of hemorrhage（P〈0.05）.The total accuracy rate of hemorrhage probability risk prediction model was 84.375%.Conclusion The patients with cirrhosis bad serum albumin,platelet,prothrombin time,portal venous diameter,splenic vein trunk diameter,size of esophageal varices,peptic ulcer,and red color sign have big risk of hemorrhage.

关 键 词：肝硬化 食管胃底静脉曲张破裂出血 风险预测模型 

分 类 号：R575.2[医药卫生—消化系统]