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肝硬化食管胃静脉曲张出血患者胃镜治疗术后再出血的影响因素分析

连佳 韩涛 向慧玲 杨言开 李庭红 刘磊 徐佰国 孙立霞 王菲 付彦超

连佳, 韩涛, 向慧玲, 等. 肝硬化食管胃静脉曲张出血患者胃镜治疗术后再出血的影响因素分析[J]. 临床肝胆病杂志, 2021, 37(9): 2092-2096. DOI: 10.3969/j.issn.1001-5256.2021.09.018
引用本文: 连佳, 韩涛, 向慧玲, 等. 肝硬化食管胃静脉曲张出血患者胃镜治疗术后再出血的影响因素分析[J]. 临床肝胆病杂志, 2021, 37(9): 2092-2096. DOI: 10.3969/j.issn.1001-5256.2021.09.018
LIAN J, HAN T, XIANG HL, et al. Influencing factors of rebleeding after gastroscopy in patients with liver cirrhosis and esophagogastric variceal bleeding[J]. J Clin Hepatol, 2021, 37(9): 2092-2096. DOI: 10.3969/j.issn.1001-5256.2021.09.018
Citation: LIAN J, HAN T, XIANG HL, et al. Influencing factors of rebleeding after gastroscopy in patients with liver cirrhosis and esophagogastric variceal bleeding[J]. J Clin Hepatol, 2021, 37(9): 2092-2096. DOI: 10.3969/j.issn.1001-5256.2021.09.018

肝硬化食管胃静脉曲张出血患者胃镜治疗术后再出血的影响因素分析

DOI: 10.3969/j.issn.1001-5256.2021.09.018
基金项目: 

国家艾滋病和病毒性肝炎等重大传染病防治科技专项课题 2017ZX10203202

详细信息
    通讯作者:

    韩涛,hantaomd@126.com

  • 中图分类号: R575.2

Influencing factors of rebleeding after gastroscopy in patients with liver cirrhosis and esophagogastric variceal bleeding

Funds: 

National Science and Technology Major Project on Prevention and Treatment of Major Infectious Diseases Including AIDS and Viral Hepatitis 2017ZX10203202

  • 摘要:   目的  分析肝硬化食管胃静脉曲张出血患者胃镜治疗术后再出血的影响因素。  方法  回顾性分析2017年1月1日—2018年12月31日于天津市第三中心医院住院的肝硬化食管胃静脉曲张出血并行胃镜治疗的患者临床资料,依据是否发生再出血及出血时间,分为未出血组(n=148)与出血组(n=119),分析影响胃镜治疗术后再出血的危险因素。计量资料两组间比较采用t检验或Mann-Whitney U秩和检验; 计数资料两组间比较采用χ2检验。采用Cox回归模型进行单因素及多因素分析。应用受试者工作特征(ROC)曲线评估Child-Turcotte-Pugh(CTP)评分、肝纤维化4因子指数(FIB-4)、白蛋白-胆红素(ALBI)评分预测胃镜治疗术后再出血的准确性; 使用MedCalc软件比较ROC曲线下面积(AUC)的差异。  结果  共纳入267例肝硬化食管胃静脉曲张出血患者,其中合并肝癌患者53例(19.9%)。119例患者发生再出血,总再出血率为44.6%,中位再出血时间为11.0(0~39.0)个月。Cox单因素分析结果显示肝癌(HR=0.377,P<0.001)、AST(HR=1.002,P=0.025)、血Na(HR=0.935,P=0.004)、FIB-4(HR=1.030,P=0.049)均与再出血相关; Cox多因素分析结果显示肝癌(HR=0.357,P<0.001)、AST(HR=1.003,P=0.030)、PT(HR=0.196,P=0.001)、CTP(HR=1.289,P=0.014)、FIB-4(HR=1.062,P=0.033)、ALBI(HR=0.433,P=0.011)均是再出血的独立影响因素。CTP、FIB-4、ALBI评分预测再出血的AUC分别为0.711(95%CI:0.647~0.776)、0.705(95%CI:0.640~0.770)、0.730(95%CI:0.667~0.793)。CTP、FIB-4、ALBI 3个评分的AUC比较,差异均无统计学意义(P值均>0.05)。  结论  肝硬化食管胃静脉曲张出血行胃镜治疗的患者,肝癌、AST、PT、CTP、FIB-4、ALBI均与胃镜治疗术后再出血有关,其中CTP、FIB-4、ALBI 3项评分对再出血结局均有很好的预测价值,且预测能力无差异。

     

  • 图  1  CTP、FIB-4、ALBI评分系统预测再出血的ROC曲线

    表  1  未出血组与出血组患者基线特征比较

    变量 未出血组(n=148) 出血组(n=119) 统计值 P
    年龄(岁) 56.76±11.33 57.15±11.64 t=-0.279 0.780
    性别[例(%)] χ2=0.030 0.899
      男 93(62.8) 76(63.9)
      女 55(37.2) 43(36.1)
    AST(U/L) 32.00(22.25~49.75) 37.00(24.00~69.00) Z=-1.541 0.123
    ALT(U/L) 24.00(16.00~37.75) 24.00(18.00~41.00) Z=-0.927 0.354
    TBil(μmol/L) 21.45(15.13~33.53) 18.80(14.10~32.60) Z=-1.132 0.258
    Alb(g/L) 31.25±5.55 32.40±5.80 t=-1.656 0.099
    PT(s) 16.89±2.88 16.38±2.97 t=1.410 0.160
    INR 1.38±0.30 1.34±0.32 t=1.111 0.268
    WBC(×109/L) 4.33(2.77~6.50) 4.46(2.98~6.68) Z=-0.706 0.480
    PLT(×109/L) 72.00(52.00~107.75) 88.00(56.00~15.00) Z=-0.940 0.347
    Hb(g/L) 84.05±18.89 85.03±21.07 t=-0.399 0.690
    Cr(μmol/L) 61.55(52.08~81.78) 62.00(51.00~74.00) Z=-0.077 0.939
    BUN(mmol/L) 7.30(5.14~9.81) 7.47(4.66~9.72) Z=-0.169 0.866
    Na(mmol/L) 139.33±3.86 138.39±3.64 t=2.036 0.043
    脾长(cm) 15.27±2.41 15.33±2.78 t=-0.177 0.860
    肝癌[例(%)] χ2=8.381 0.005
      否 128(86.5) 86(72.3)
      是 20(13.5) 33(27.7)
    CTP分级[例(%)] χ2=0.792 0.673
      A级 67(45.3) 58(48.7)
      B级 65(43.9) 46(38.7)
      C级 16(10.8) 15(12.6)
    PLTSLE评分(分) 444.76(335.45~690.68) 516.67(322.40~762.59) Z=-1.214 0.225
    APRI评分(分) 1.12(0.71~1.91) 1.17(0.75~2.34) Z=-0.878 0.380
    FIB-4评分(分) 5.53(3.31~8.21) 5.37(3.18~8.69) Z=-0.542 0.588
    GBS评分(分) 10.61±3.03 10.47±3.22 t=0.376 0.707
    ALBI评分(分) -1.47±0.57 -1.60±0.66 t=1.743 0.083
    MELD评分(分) 11.82±3.87 11.14±3.81 t=1.425 0.155
    是否随访内镜治疗[例(%)] χ2=0.114 0.799
      是 53(35.8) 74(62.2)
      否 95(64.2) 45(37.8)
    内镜随访治疗(次) 0(0~1) 0(0~1) Z=-0.263 0.792
    下载: 导出CSV

    表  2  再出血影响因素Cox回归分析

    因素 单因素分析 多因素分析
    HR(95%CI) P HR(95%CI) P
    性别 1.065(0.732~1.548) 0.743
    年龄 1.004(0.988~1.020) 0.661
    肝癌 0.377(0.251~0.566) <0.001 0.357(0.220~0.581) <0.001
    AST 1.002(1.000~1.003) 0.025 1.003(1.000~1.005) 0.030
    ALT 1.002(0.998~1.005) 0.405
    TBil 1.002(0.993~1.010) 0.697
    Alb 1.014(0.983~1.047) 0.387
    PT 0.957(0.892~1.028) 0.228 0.196(0.077~0.498) 0.001
    INR 0.735(0.381~1.422) 0.361
    PLT 1.001(0.997~1.004) 0.788
    Hb 1.001(0.991~1.010) 0.890
    Cr 0.999(0.994~1.004) 0.683
    Na 0.935(0.893~0.979) 0.004
    CTP评分 1.037(0.939~1.144) 0.474 1.289(1.053~1.576) 0.014
    PLTSLE评分 1.000(1.000~1.001) 0.134
    APRI评分 1.029(0.972~1.090) 0.329
    FIB-4评分 1.030(1.000~1.061) 0.049 1.062(1.005~1.122) 0.033
    GBS评分 0.996(0.940~1.055) 0.895
    ALBI评分 0.870(0.643~1.177) 0.366 0.433(0.228~0.823) 0.011
    MELD评分 0.977(0.928~1.027) 0.362
    是否随访内镜治疗 1.091(0.753~1.582) 0.644
    随访治疗次数 0.935(0.794~1.100) 0.416
    下载: 导出CSV
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  • 收稿日期:  2021-01-20
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