ESVD治疗肝硬化伴急性食管胃底静脉曲张破裂出血远期疗效及再出血风险模型构建  

Long-term efficacy and rebleeding risk model of esophagogastric variceal bleeding(ESVD)in treatment of liver cirrhosis with acute esophagogastric variceal bleeding(EGVB)

作　　者：王巧珍 邵校 杨修玲 蔡奉娟 WANG Qiaozhen;SHAO Xiao;YANG Xiuling;CAI Fengjuan(Digestive Endoscopy Center,Suqian Hospital,Jiangsu Provincial People's Hospital,Suqian Jiangsu 223800,China;Department of Gastroenterology,Suqian Hospital,Jiangsu Provincial People's Hospital,Suqian Jiangsu 223800,China)

机构地区：[1]江苏省人民医院宿迁医院消化内镜中心,江苏宿迁223800 [2]江苏省人民医院宿迁医院消化内科,江苏宿迁223800

出　　处：《新疆医科大学学报》2025年第3期344-349,355,共7页Journal of Xinjiang Medical University

基　　金：江苏省医学重点学科项目(ZDXK202288)。

摘　　要：目的分析内镜下食管胃底静脉曲张精准断流术(ESVD)治疗肝硬化伴急性食管胃底静脉曲张破裂出血(EGVB)远期疗效及再出血的独立危险因素,并基于危险因素构建风险模型。方法选取2016年3月至2023年10月江苏省人民医院宿迁医院收治的肝硬化伴急性EGVB患者237例作为研究对象。所有患者均经过ESVD治疗,并随访观察1年。观察术后1年患者内镜下静脉曲张清除效果及再出血情况。根据再出血情况进行分组,再出血组(n=46)和未再出血组(n=191)。分析两组临床资料,采用多因素Logistic回归分析法明确患者危险因素,以上述危险因素构建风险列线图,采用Bootstrap法验证模型区分度,绘制Calibration曲线和受试者工作特征(ROC)曲线评估拟合度及预测效能。结果术后1年,114例静脉曲张完全根除,78例基本消失,45例未消失,清除率为81.01%。237例患者首次进行ESVD后,随访1年内发生再出血的患者有46例,发生率为19.41%。再出血组治疗前曲张静脉直径,中、大量腹水占比,Child-Pugh分级C级评分占比,有红色征占比及谷丙转氨酶(ALT)、凝血酶原时间(PT)水平高于未再出血组,而血小板(PLT)、血钠(Na)浓度则低于未再出血组(P<0.05)。多因素Logistic回归模型显示,治疗前曲张静脉直径偏大,中、大量腹水,PT时间延长是导致肝硬化伴EGVB患者经ESVD治疗后发生再次出血的独立危险因素,高浓度血Na则是其保护因素(P<0.05)。基于筛选出的4项独立危险因素构建患者再出血的风险列线图并进行内部验证显示拟合度好(Hosmer-Lemeshowχ^(2)=1.305,P=0.113),预测模型的AUC为0.915(95%CI:0.859~0.954,P<0.05),预测效能较好。结论ESVD治疗肝硬化伴急性EGVB具有良好的远期疗效,本研究构建的再出血风险模型具有良好的临床实用价值,可为临床医务人员早期识别肝硬化伴急性EGVB患者制定相应的防控措施提供参考。Objective To analyze the long-term efficacy and independent risk factors of esophagogastric variceal bleeding(ESVD)in the treatment of liver cirrhosis with acute esophagogastric variceal bleeding(EGVB),and to establish a risk model based on the risk factors.Methods 237 patients with liver cirrhosis and acute EGVB admitted to the hospital from March 2016 to October 2023 were selected as the study objects.All patients underwent ESVD treatment and were followed up for 1 year.The results of endoscopic varicose removal and rebleeding were observed for 1 year.Groups were divided according to the condition of rebleeding,rebleeding group(n=46)and no rebleeding group(n=191).The clinical data of the 2 groups were analyzed,and the risk factors of the patients were identified by multi-factor Logistic regression analysis.The risk nomogram was constructed based on the above risk factors,the calibration curve and receiver operating characteristic(ROC)curve were drawn to evaluate the fit and prediction efficiency.Results 1 year postoperative the varicose was completely eradicated in 114 cases,disappeared in 78 cases and did not disappear in 45 cases,with a clearance rate of 81.01%.Among the 237 patients who underwent ESVD for the first time,46 had rebleeding within 1 year of follow-up,with an incidence of 19.41%.The varicose vein diameter,the proportion of medium and large ascites,the proportion of C-child-pugh score,the proportion of red and the levels of alanine aminotransferase(ALT)and prothrombin time(PT)in the rebleeding group were higher than those in the group without rebleeding before treatment,while the platelet(PLT)and blood sodium(Na)concentrations were lower than those in the group without rebleeding(P<0.05).Multivariate Logistic regression model showed that large varicose vein diameter,medium and large amount of ascites,and prolonged PT time before the treatment were independent risk factors for recurrent bleeding after ESVD in patients with liver cirrhosis and EGVB,and high blood Na was protective factor(P<0.05).Ba

关 键 词：肝硬化 急性食管胃底静脉曲张破裂出血 远期疗效 列线图 风险评估模型 

分 类 号：R571.3[医药卫生—消化系统]