FAR、RLR水平对乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者治疗后再出血风险的评估价值  

Value of FAR and RLR Levels in Evaluating the Risk of Rebleeding in Patients with Hepatitis B Cirrhosis and Esophagogastric Variceal Bleeding after Treatment

作　　者：陈玉凤 明文[1] 陈镜晶 王茜 李溢馨 CHEN Yu-feng;MING Wen;CHEN Jing-jing;WANG Qian;LI Yi-xin(Department of Gastroenterology,Chuanbei Medical College Affiliated Hospital,Nanchong,Sichuan,637000,China)

机构地区：[1]川北医学院附属医院消化内科,四川南充637000

出　　处：《现代生物医学进展》2025年第1期72-79,共8页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(81871440)。

摘　　要：目的:探讨乙型肝炎肝硬化并发食管胃底静脉曲张出血(EGVB)患者纤维蛋白原/白蛋白比值(FAR)、红细胞分布宽度/淋巴细胞比值(RLR)预测治疗后再出血的临床价值。方法:选取2021年1月~2023年10月我院收治的乙型肝炎肝硬化并发EGVB患者155例(EGVB组)和同期收治的单纯乙型肝炎肝硬化患者100例(非EGVB组),计算FAR、RLR,根据治疗后是否再次出血将乙型肝炎肝硬化并发EGVB患者分为再出血组(63例)和无再出血组(92例)。多因素Logistic回归确定再出血的影响因素,绘制受试者工作特征(ROC)曲线分析FAR、RLR对其的预测能效。结果:EGVB组FAR(0.032±0.010)低于非EGVB组(0.045±0.010),RLR(15.26±5.06)高于非EGVB组(8.51±3.36)(t=-10.554、12.798,P均<0.05)。随访6个月,155例乙型肝炎肝硬化并发EGVB患者经治疗后再出血率为40.65%(63/155)。再出血组FAR(0.029±0.004)低于无再出血组(0.034±0.009),RLR(18.45±5.36)高于无再出血组(13.36±4.86)(t=-4.792、6.147,P均<0.05)。乙型肝炎肝硬化并发EGVB患者治疗后再出血的独立危险因素为门静脉内径大(OR=1.364,95%CI:1.125~1.655,P=0.002)、重度食管胃底静脉曲张(OR=7.204,95%CI:1.292~40.179,P=0.024)、RLR升高(OR=1.194,95%CI:1.094~1.304,P<0.001),独立保护因素为FAR升高(OR=0.160,95%CI:0.052~0.490,P=0.001)。FAR、RLR联合预测乙型肝炎肝硬化并发EGVB患者治疗后再出血的曲线下面积(AUC)为0.854(95%CI:0.788~0.905),大于FAR、RLR单独预测的0.754(95%CI:0.678~0.819)、0.781(95%CI:0.707~0.843)。结论:乙型肝炎肝硬化并发EGVB患者FAR降低和RLR升高,与治疗后再出血密切相关,FAR、RLR联合对乙型肝炎肝硬化并发EGVB患者治疗后再出血有较高的预测价值。Objective:To investigate the clinical value of fibrinogen/albumin ratio(FAR)and red blood cell distribution width/lymphocyte ratio(RLR)in predicting rebleeding after treatment in patients with hepatitis B cirrhosis and esophagogastric variceal bleeding(EGVB).Methods:155 patients with hep-atitis B cirrhosis and EGVB(EGVB group)and 100 patients with hepatitis B cirrhosis(non-EGVB group)admitted to our hospital from January 2021 to October 2023 were selected,the FAR and RLR were calculated,patients with hepatitis B cirrhosis and EGVB were divided into rebleeding group(63 cases)and non-rebleeding group(92 cases)according to whether there was rebleeding after treatment.The influ-encing factors of rebleeding were determined by multivariate Logistic regression,and the predictive energy efficiency of FAR and RLR were analyzed by receiver operating characteristic curve.Results:The FAR in EGVB group(0.032±0.010)was lower than that in non-EGVB group(0.045±0.010),and the RLR(15.26±5.06)was higher than that in non-EGVB group(8.51±3.36)(t=-10.554,12.798,all P<0.05).6 months after follow-up,the rebleeding rate of 155 patients with hepatitis B cirrhosis ang EGVB was 40.65%(63/155).The FAR in rebleeding group(0.029±0.004)was lower than that in non-rebleeding group(0.034±0.009),and RLR(18.45±5.36)was higher than that in non-rebleeding group(13.36±4.86)(t=-4.792,6.147,P<0.05).The independent risk factors for rebleeding after treatment in patients with hepatitis B cirrhosis and EGVB were large portal vein diameter(OR=1.364,95%CI:1.125-1.655,P=0.002),severe esophagogastric varices(OR=7.204,95%CI:1.292-40.179,P=0.024),and increased RLR(OR=1.194,95%CI:1.094-1.304,P<0.001),the independent protective factor was increased FAR(OR=0.160,95%CI:0.052-0.490,P=0.001).The area under the curve(AUC)of combined FAR and RLR in predicting rebleeding after treatment in patients with hepatitis B cirrhosis and EGVB was 0.854(95%CI:0.788-0.905),which was greater than 0.754(95%CI:0.678-0.819)and 0.781(95%CI:0.707-0.843)predicted by FAR and RLR alo

关 键 词：乙型肝炎肝硬化 食管胃底静脉曲张出血 纤维蛋白原/白蛋白比值 红细胞分布宽度/淋巴细胞比值 再出血 

分 类 号：R57[医药卫生—消化系统]