乙型肝炎肝硬化并发胃食管静脉曲张内镜治疗后再出血的风险预测模型的建立  

Risk Prediction Model for Rebleeding After Endoscopic Variceal Ligation in HBV-Related Cirrhosis Patients with Gastroesophageal Varices

作　　者：杨廷廷 韩帅 孔凡国 曲效磊 YANG Tingting;HAN Shuai;KONG Fangguo;QU Xiaolei(Department of Gastroenterology,Jinan People's Hospital,Jinan,Shandong 271100,China;Department of Surgery,Qingdao Jimo District Hospital of Chinese Medicine,Qingdao,Shandong 266299,China)

机构地区：[1]山东省济南市人民医院消化内科,山东济南271100 [2]山东省青岛市即墨区中医院外科,山东青岛266299

出　　处：《转化医学杂志》2024年第5期762-767,共6页Translational Medicine Journal

基　　金：山东省中医药科技项目(2021M117)。

摘　　要：目的探讨乙型肝炎肝硬化胃食管静脉曲张内镜下食管静脉曲张套扎术(EVL)后再出血的危险因素,构建预测模型。方法回顾性分析294例EVL治疗乙型肝炎肝硬化胃食管静脉曲张患者的临床资料。随访术后随访1年再出血发生情况。多因素Logistic回归分析影响乙型肝炎肝硬化胃食管静脉曲张患者EVL术后再出血的因素,基于Logistic回归构建预测模型,受试者工作特征(ROC)曲线和Hosmer-Lemeshow检验预测模型预测乙型肝炎肝硬化胃食管静脉曲张患者EVL术后再出血的效能。结果294例乙型肝炎肝硬化胃食管静脉曲张患者EVL术后发生再出血73例,再出血率为24.83%。多因素分析结果显示:高肝静脉压力梯度(HVPG)、门静脉血栓、Child-Pugh C级是乙型肝炎肝硬化胃食管静脉曲张患者EVL术后再出血的独立危险因素,抗病毒治疗是独立保护因素(P<0.05)。Hosmer-Lemeshow检验基于Logistic回归的预测模型与观测值拟合度较好(P>0.05),ROC曲线分析预测模型预测乙型肝炎肝硬化胃食管静脉曲张患者EVL术后再出血的曲线下面积(AUC)为0.844,效能较高(P<0.05)。结论高HVPG、门静脉血栓、Child-Pugh C级是乙型肝炎肝硬化胃食管静脉曲张患者EVL术后再出血的独立危险因素,抗病毒治疗是独立保护因素,据此建立预测模型具有较好的预测效能。Objective To investigate the risk factors for rebleeding after endoscopic esophageal variceal ligation(EVL)in patients with HBV-related cirrhosis and to establish a predictive model.Methods A total of 294 patients with HBV-related cirrhosis and gastroesophageal varices treated with EVL were retrospectively analyzed.Rebleeding incidence and clinical data were collected during a 1-year postoperative follow-up.Multivariate Logistic regression analysis was performed to identify factors influencing rebleeding.A predictive model was constructed based on Logistic regression.The model's efficacy was evaluated using receiver operating characteristic(ROC)curves and Hosmer-Lemeshow tests.Results Among 294 patients,rebleeding occurred in 73 cases,with a rebleeding rate of 24.83%.Multivariate Logistic regression analysis indicated that high HVPG,portal vein thrombosis,and Child-Pugh grade C were independent risk factors,while antiviral therapy was a protective factor(P<0.05).The Hosmer-Lemeshow test demonstrated a good fit between the predictive model and observed data(P>0.05).ROC analysis showed that the area under the curve(AUC)for predicting rebleeding was 0.844,indicating high predictive efficacy(P<0.05).Conclusion High HVPG,portal vein thrombosis,and Child-Pugh grade C are risk factors for rebleeding after EVL in HBV-related cirrhosis patients with gastroesophageal varices,while antiviral therapy serves as a protective factor.The predictive model shows good performance and is valuable for clinical decision-making.

关 键 词：乙型肝炎肝硬化 胃食管静脉曲张 内镜下食管静脉曲张套扎术 再出血 

分 类 号：R575.2[医药卫生—消化系统]