食管胃底静脉曲张破裂出血内镜治疗效果及1年内再出血风险预测模型的构建及验证  

Outcomes of Endoscopic Treatment of Esophagogastric Variceal Bleeding and Construction and Validation of a 1-Year Rebleeding Risk Prediction Model

作　　者：杨建波 黄小梅 何远静 张丽丽 罗玉君 YANG Jianbo;HUANG Xiaomei;HE Yuanjing;ZHANG Lili;LUO Yujun(Department of Gastroenterology,Mianyang Hospital Affiliated to School of Medicine,University of Electronic Science and Technology of China·Mianyang Central Hospital,Mianyang 621000,China)

机构地区：[1]电子科技大学医学院附属绵阳医院·绵阳市中心医院消化内科,绵阳621000

出　　处：《四川大学学报(医学版)》2025年第1期284-290,共7页Journal of Sichuan University(Medical Sciences)

基　　金：2020年四川省医学重点学科(实验室)及重点专科立项建设项目(No.20PJ263)资助。

摘　　要：目的探究内镜治疗食管胃底静脉曲张破裂出血(esophageal and gastric varices bleeding,EGVB)的疗效,对治疗患者1年内再出血的风险因素进行调查,并对应建立预测模型。方法回顾性纳入2021年1月–2022年12月于我院接受内镜治疗的120例EGVB患者临床及随访资料,分析内镜治疗效果,并根据治疗后1年内再出血情况分为出血组和非出血组,分析影响患者治疗后1年内再出血的因素并建立预测模型(logistic回归分析法),评估模型拟合度(Hosmer-Lemeshow检验),分析其临床价值〔受试者工作特征(receiver operating characteristic,ROC)曲线〕。结果120例患者内镜治疗后72 h止血成功率100%;内镜治疗后4周内镜复查显示静脉曲张完全消失和基本消失率75.83%(91/120),再出血10例(8.33%);内镜治疗后6个月、1年累积再出血34例(28.33%)、63例(52.50%),内镜治疗后1年内死亡9例(7.50%),均为再出血患者。63例发生再出血者纳入再出血组,57例未发生再出血者纳入非再出血组。血清钠<135 mmol/L〔比值比(odds ratio,OR)=3.837,95%置信区间(confidence interval,CI):1.095~13.445)、Child-Pugh分级C级(OR=3.835,95%CI:1.137~12.935)、食管静脉曲张程度G3(OR=5.113,95%CI:1.565~16.707)、门静脉主干内径>12 mm(OR=5.964,95%CI:2.295~15.497)为EGVB内镜治疗患者1年内再出血的风险因素(P<0.05);EGVB患者内镜治疗后1年内再出血的风险预测模型P=1/{1+e^([−(−3.815+1.345×血清钠+1.344×Child-Pugh分级+1.786×门静脉主干内径+1.632×食管静脉曲张程度)])},Hosmer-Lemeshowχ^(2)=3.158,P=0.856,模型预测EGVB患者内镜治疗后1年内再出血的曲线下面积(area under the curve,AUC)为0.815,预测效能较好。临床验证该模型预测再出血的准确率为82.30%,敏感度、特异度分别为81.03%、83.63%。结论内镜治疗EGVB的急性出血控制率高,但仍存在再出血风险,且再出血与血清钠<135 mmol/L、Child-Pugh分级C级、门静脉主干内径>12 mm、食管静脉曲张Objective To explore the efficacy of endoscopic therapy for esophageal and gastric variceal bleeding(EGVB),investigate the risk factors for rebleeding within 1 year,and establish a predictive model accordingly.Methods A retrospective study was conducted using the clinical and follow-up data of 120 EGVB patients who underwent endoscopy at our hospital between January 2021 and December 2022.The efficacy of endoscopic therapy was analyzed,and the patients were divided into a bleeding group and a non-bleeding group based on whether rebleeding occurred within 1 year after treatment.The factors influencing rebleeding within 1 year after treatment were analyzed,and a predictive model was established using logistic regression analysis.The model's goodness of fit was evaluated using the Hosmer-Lemeshow test,and its clinical value was analyzed using the receiver operating characteristic(ROC)curve.Results The hemostasis success rate within 72 hours after endoscopic therapy was 100%in all 120 patients.Four weeks after endoscopic treatment,endoscopic reexamination showed that the complete and partial disappearance rate of varices was 75.83%(91/120),with rebleeding occurring in 10 cases(8.33%).There were 34 cases(28.33%)of cumulative rebleeding at 6 months and 63 cases(52.50%)at 1 year after endoscopic therapy.Nine patients(7.50%)died within 1 year after endoscopic therapy,all of whom were rebleeding cases.A total of 63 patients with rebleeding were included in the bleeding group,and 57 patients without rebleeding were included in the non-bleeding group.Serum sodium<135 mmol/L(odds ratio[OR]=3.837,95%confidence interval[CI]:1.095-13.445),Child-Pugh grade C(OR=3.835,95%CI:1.137-12.935),esophageal varices degree G3(OR=5.113,95%CI:1.565-16.707),and main portal vein diameter>12 mm(OR=5.964,95%CI:2.295-15.497)were identified as risk factors of rebleeding within 1 year after endoscopic therapy in EGVB patients(P<0.05).The risk prediction model for rebleeding within 1 year after endoscopic therapy in EGVB patients was shown as P=1/{1

关 键 词：食管胃底静脉曲张 出血 内镜下静脉曲张套扎术 内镜下硬化剂注射术 风险 

分 类 号：R575.2[医药卫生—消化系统]