肝硬化合并消化道出血患者行内镜治疗后再出血预测模型的建立与验证  

Establishment and Validation of a Predictive Model for Recurrent Bleeding in Liver Cirrhosis Patients with Gastrointestinal Bleeding After Endoscopic Treatment

作　　者：汤信鹏 冯娟[1] 范晓棠[1] TANG Xinpeng;FENG Juan;FAN Xiaotang(The Second Department of Gastroenterology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,Xinjiang,China)

机构地区：[1]新疆医科大学第一附属医院消化病二科,新疆乌鲁木齐830054

出　　处：《医学信息》2025年第9期27-32,共6页Journal of Medical Information

基　　金：新疆维吾尔自治区自然科学基金资助项目(编号:2022D01C234)。

摘　　要：目的构建肝硬化合并上消化道出血患者行内镜治疗后再出血的预测模型,并验证此模型的预测价值。方法纳入2017年1月-2021年12月我院收治的352例肝硬化伴消化道再出血患者作为研究对象,按患者内镜治疗后2年内是否发生消化道再出血分为未出血组199例和出血组153例。采用单因素及多因素Logistic回归分析肝硬化合并上消化道出血患者行内镜治疗后再出血的影响因素,基于独立预测因素构建列线图模型,绘制ROC曲线和决策曲线,分析独立预测因素及联合预测的预测效能和净收益率。结果单因素分析显示,两组BMI、门静脉内径、Child-Pugh分级、食管胃底静脉曲张程度、Hp感染、门静脉血栓形成及出血量比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,门静脉内径、Child-Pugh分级、食管胃底静脉曲张程度、Hp感染以及出血量为肝硬化合并消化道出血患者行内镜治疗后再出血的独立预测因素(P<0.05);构建列线图模型:P=1/(1+e-x),X=0.002×出血量(ml)+1×Child-Pugh分级(A=0,B=0.890,C=1.440)+1×食管胃底静脉曲张(轻度=0,中度=1.886,重度=2.773)+1.470×门静脉内径(cm)+2.574×Hp感染(是=1,否=0)-1.895;拟合优度(H-L)检验结果显示,肝硬化合并消化道出血患者行内镜治疗后再出血风险的的预测值与实际观测值符合度良好(χ^(2)=0.305,P=0.815);ROC分析显示,联合预测肝硬化合并消化道出血患者行内镜治疗后再出血的曲线下面积(AUC)为0.863(95%CI:0.824~0.902);决策曲线分析显示,独立预测因素以及联合预测肝硬化合并消化道出血患者行内镜治疗后再出血均具有良好的净收益率。结论本研究构建的列线图模型具有良好的预测效能和净收益率,能用于准确预测肝硬化合并消化道出血患者行内镜治疗后再出血风险。Objective To establish a predictive model for recurrent bleeding in liver cirrhosis patients with upper gastrointestinal bleeding after endoscopic treatment,and to verify the predictive value of this model.Methods A total of 352 liver cirrhosis patients with gastrointestinal rebleeding admitted to our hospital from January 2017 to December 2021 were included as the study subjects.They were divided into a non bleeding group of 199 cases and a bleeding group of 153 cases according to whether the patients experienced gastrointestinal rebleeding within 2 years after endoscopic treatment.Univariate and multivariate logistic regression were used to analyze the influencing factors of rebleeding after endoscopic treatment in patients with liver cirrhosis complicated with upper gastrointestinal bleeding.A column chart model was constructed based on the independent predictive factors.ROC curves and decision curves were drawn,and the predictive efficiency and net return of independent predictive factors and joint prediction were analyzed.Results Univariate analysis showed that there were significant differences in BMI,portal vein diameter,Child-Pugh classification,degree of esophageal and gastric varices,Hp infection,portal vein thrombosis and bleeding volume between the two groups(P<0.05).Multivariate Logistic regression analysis showed that portal vein diameter,Child-Pugh classification,degree of esophagogastric varices,Hp infection and bleeding volume were independent predictors of rebleeding after endoscopic treatment in patients with cirrhosis and gastrointestinal bleeding(P<0.05).A column chart model was established:P=1/(1+e-x),X=0.002×bleeding volume(ml)+1×Child-Pugh grade(A=0,B=0.890,C=1.440)+1×Gsophageal and gastric varices(Mild=0,Moderate=1.886,Severe=2.773)+1.470×Portal vein diameter(cm)+2.574×Hp infection(Yes=1,No=0)-1.895.The result of goodness of fit(H-L)test showed that the predicted value of the risk of rebleeding after endoscopic treatment in liver cirrhosis patients with gastrointestinal bleeding was

关 键 词：肝硬化 消化道出血 内镜治疗 预测模型 

分 类 号：R573.2[医药卫生—消化系统]