肝硬化血清标志物对腹腔镜脾切除联合贲门周围血管离断术后发生食管胃底曲张静脉再出血预测价值的前瞻性研究  

The value of liver fibrosis serum markers in predicting esophagogastric variceal re-bleeding after laparoscopic splenectomy and azygoportal disconnection:a prospective study

作　　者：吴鑫灿 蒋国庆 柏斗胜 金圣杰 张弛 王谦 周保换 王翱卿 吴龙飞 Wu Xincan;Jiang Guoqing;Bai Dousheng;Jin Shengjie;Zhang Chi;Wang Qian;Zhou Baohuan;Wang Aoqing;Wu Longfei(The Second Clinical Medicical School of Nanjing Medical University,Nanjing 210011,China;Depart-ment of Hepatobiliary Surgery,Clinical Medical College,Yangzhou University,Yangzhou 225001,China)

机构地区：[1]南京医科大学第二临床医学院,南京210011 [2]扬州大学临床医学院肝胆外科,扬州225001

出　　处：《中华消化外科杂志》2022年第8期1093-1098,共6页Chinese Journal of Digestive Surgery

基　　金：江苏省青年医学人才资助项目(NQRC2016331);江苏省六大人才高峰资助项目(WSW230)。

摘　　要：目的探讨肝硬化血清标志物对腹腔镜脾切除联合贲门周围血管离断术后发生食管胃底曲张静脉再出血(EGVR)的预测价值。方法采用前瞻性研究方法。选取2014年9月至2017年1月扬州大学临床医学院收治的155例肝硬化门静脉高压症行腹腔镜脾切除联合贲门周围血管离断术后发生EGVR患者的临床资料。观察指标:(1)入组患者情况。(2)术后发生EGVR的危险因素分析。(3)术后发生EGVR的预测情况。(4)随访情况。采用电话、门诊和住院方式进行随访。术后每3个月随访1次。了解患者术后发生EGVR及死亡情况。随访时间截至2018年1月。正态分布的计量资料以x±s表示,组间比较采用t检验;偏态分布的计量资料以M(范围)表示,组间比较采用非参数检验。计数资料以绝对数表示,组间比较采用χ^(2)检验或Fisher确切概率法。多因素分析采用Logistic回归模型。采用受试者工作特征曲线下面积(AUC)评估诊断效能,约登指数确定最佳截断值。结果(1)入组患者情况。筛选出符合条件的患者155例;男106例,女49例;年龄为(53±11)岁。155例患者中,术后1年内发生EGVR 21例,未发生EGVR 134例。发生EGVR和未发生EGVR患者层粘连蛋白、Ⅳ型胶原分别为100.3(16.1~712.2)μg/L、68.4(35.0~198.8)μg/L和35.5(2.0~521.2)μg/L、43.5(4.3~150.4)μg/L,两者比较,差异均有统计学意义(Z=-4.55,-4.52,P<0.05)。(2)术后发生EGVR的危险因素分析。根据约登指数,层粘连蛋白最佳截断值为64μg/L,Ⅳ型胶原最佳截断值为65μg/L。多因素分析结果显示:层粘连蛋白≥64μg/L,Ⅳ型胶原≥65μg/L是患者术后发生EGVR的独立危险因素(优势比=9.69,8.16,95可信区间为3.05~30.82,2.65~25.15,P<0.05)。(3)术后发生EGVR的预测情况。受试者工作特征曲线分析结果显示:层粘连蛋白和Ⅳ型胶原预测术后发生EGVR的AUC为0.79(95%可信区间为0.66~0.92),灵敏度为0.62,特异度为0.96。(4)随访情况。155例患者均Objective To investigate the value of liver fibrosis serum markers in predicting esophagogastric variceal re-bleeding(EGVR)after laparoscopic splenectomy and azygoportal discon-nection(LSD).Methods The prospective study was conducted.The clinical data of 155 cirrhotic portal hypertension patients with EGVR after LSD in the Clinical Medical College of Yangzhou University from September 2014 to January 2017 were selected.Observation indicators:(1)grouping situations of the enrolled patients;(2)risk factors analysis for postoperative EGVR;(3)prediction of postoperative EGVR;(4)follow-up.Follow-up was conducted using telephone interview,outpatient examination and hospitalization.Patients were followed up once every 3 months after operation to detect occurrence of EGVR and survival of patient up to January 2018.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Measurement data wite skewed distribution were represented as M(range),and comparison between groups was conducted using the non-parameter test.Count data were described as absolute numbers,and comparison between groups were conducted using the chi-square test or Fisher exact probability.Logistic regression model was used for multivariate analysis.The area under curve(AUC)of receiver operating characteristic(ROC)curve was used to estimate the diagnostic efficiency.The Youden index was used to determine the optimal cut-off point.Results(1)Grouping situations of the enrolled patients.A total of 155 patients were selected for eligibility.There were 106 males and 49 females,aged(53±11)years.Of the 155 patients,there were 21 cases with EGVR in the postoperative 1 year and 134 cases without EGVR in the postoperative 1 year.The protein expression of laminin and collagenⅣwere 100.3(range,16.1‒712.2)µg/L and 68.4(range,35.0‒198.8)µg/L in patients with EGVR,vs 35.5(range,2.0‒521.2)µg/L and 43.5(range,4.3‒150.4)µg/L in patients without EGVR,showing significant differences betwe

关 键 词：门静脉高压症 肝硬化标志物 脾切除术 贲门周围血管离断术 上消化道再出血 腹腔镜检查 

分 类 号：R575.2[医药卫生—消化系统]