胃肾分流道直径对合并胃肾分流道胃静脉曲张患者二级预防疗效的影响  

Influence of the diameter of gastrorenal shunt on the efficacy of secondary prophylaxis in gastric yarices patients withgastrorenal shunntt

作　　者：王汉宇 张海栋[2] 陈明锴[1] 肖勇[1] 余保平[1] Wang Hanyu;Zhang Haidong;Chen Minghai;Xiao Yong;Yu Baoping(Department of gastroenterology,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院消化内科,武汉430060 [2]武汉大学人民医院放射科,武汉430060

出　　处：《临床内科杂志》2025年第3期221-226,共6页Journal of Clinical Internal Medicine

基　　金：湖北省卫生健康委员会科研项目(WJ2023M078)。

摘　　要：目的 评估胃肾分流道(GRS)直径对合并GRS胃静脉曲张患者二级预防疗效的影响。方法 回顾性收集2015年1月~2022年6月采用非选择性β受体阻滞剂联合内镜治疗进行二级预防的合并GRS胃静脉曲张患者306例,按照7∶3比例将其随机分为训练组(214例)和验证组(92例)。收集所有患者一般临床资料、实验室检查指标、内镜检查和影像学检查结果并分组进行比较。采用Cox回归分析评估再出血的预测因素;采用受试者工作特征(ROC)曲线评估GRS直径的最佳截断值;采用Pearson相关分析评估GRS直径与胃静脉曲张直径的相关性;采用Kaplan-Meier曲线分析结局事件的累积发生率。结果 训练组和验证组患者一般临床资料比较差异均无统计学意义(P>0.05)。多因素Cox回归分析结果显示,门静脉血栓、GRS直径、门静脉直径和PLT计数均是合并GRS胃静脉曲张患者再出血的独立预测因素(P<0.05)。Pearson相关分析结果显示,训练组及验证组患者GRS直径与胃静脉曲张直径均呈正相关(P<0.001)。GRS直径预测2年再出血率的最佳截断值为0.6 cm,据此将训练组和验证组患者分别分为S-GRS亚组(GRS直径<0.6 cm)和L-GRS亚组(GRS直径≥0.6 cm)。Kaplan-Meier曲线分析结果显示,训练组和验证组L-GRS亚组再出血、肝性脑病及死亡的累积发生率均显著高于同组S-GRS亚组(P均<0.05)。结论 GRS直径是预测合并GRS胃静脉曲张患者二级预防疗效的重要指标,GRS直径≥0.6 cm的患者发生再出血、肝性脑病和死亡的风险显著升高,可能更适合血管介入治疗。Objective To evaluate the influence of the diameter of gastrorenal shunt(GRS)on the efficacy of secondary prophylaxis in gastric varices patients with CRS.Methods A total of 306 patients with gastric varices complicated with GRS who received non-selectiveβ-blockers combined with endoscopic therapy for secondary prevention from January 2015 to June 2022 were retrospectively collected.According to the ratio of 7:3,they were randomly divided into training group(214 cases)and validation group(92 cases).General clinical data,laboratory examination indexes,endoscopic examination and imaging examination results of all patients were collected and compared between groups.Cox regression analysis was used to evaluate predictors of rebleeding,and the receiver operating characteristic(ROC)curve was used to evaluate the optimal cut-off value of GRS diameter.Pearson correlation analysis was used to evaluate the correlation between CRS diameter and gastric varices diameter.Kaplan-Meier curve was used to analyze the cumulative incidence of outcome events.Results There was no significant difference in general clinical data between training group and validation group(P>0.05).Multivariate Cox regression analysis showed that portal vein thrombosis,GRS diameter,portal vein diameter and PLT count were independent predictors of rebleeding in patients with gastric varices complicated with GRS(P<0.05).Pearson correlation analysis showed that the diameter of GRS was positively correlated with the diameter of gastric varices in training group and validation group(P<0.001).The optimal cut-ff value of CRS diameter for predicting 2-year rebleeding rate was 0.6 cm.Based on this,patients in training group and validation group were divided into S-CRS subgroup(GRS diameter<O.6 cm)and L-GRS subgroup(GRS diameter≥0.6 cm)respectively.Kaplan-Meier curve analysis showed that the cumulative incidence of recurrent rebleeding,hepatic encephalopathy and death in L-GRS subgroup was significantly higher than those in S-CRS subgroup in both training group

关 键 词：胃肾分流道 胃静脉曲张 二级预防 再出血 

分 类 号：R573.2[医药卫生—消化系统]