摘要
目的:HBV相关性肝硬化是引起门脉高压和胃肠道出血的重要原因,但对于已经出现胃肠道出血的患者而言,如何进行准确的风险分层仍是一大挑战。本研究旨在评估新型炎症标志物——单核细胞/淋巴细胞比值(monocyte/lymphocyte ratio,MLR)及全身免疫炎症指数(systemic immune inflammation index,SII)在伴有静脉曲张性出血的HBV相关性肝硬化患者中的预后价值。方法:回顾性分析2018年1月—2024年2月期间在同济大学附属第十人民医院及复旦大学附属闵行医院住院的242例伴有静脉曲张性出血的HBV相关性肝硬化患者的常规实验室检查结果,计算MLR和SII,并利用Cox回归模型确定总生存期(overall survival,OS)和复发性出血(以下简称复出血)的预测因素。将这些指标与临床参数相结合,构建一个用于此类患者风险分层的列线图。结果:多变量分析显示,MLR升高与OS降低独立相关(HR=5.10,P=0.002),而较高的SII则预测复出血风险增加(HR=1.23,P<0.001)。OS列线图将患者分为不同风险组,3年OS率从低风险组的94.5%到高风险组的58.7%不等;复出血列线图则辨识出3年复出血率分别为低风险组22.8%和高风险组62.3%。结论:MLR和SII作为成本低、易于获得的预测工具,其构建的列线图可为伴有静脉曲张性出血的HBV相关性肝硬化患者个体化风险评估提供参考。
Objective:HBV-related cirrhosis is a major cause of portal hypertension and gastrointestinal bleeding.However,accurately stratifying the risk for patients who have already experienced gastrointestinal bleeding remains a significant challenge.This study aims to assess the prognostic value of novel inflammatory markers—monocyte/lymphocyte ratio(MLR)and systemic immune inflammation index(SII)—in patients with HBV-related cirrhosis and variceal bleeding.Methods:A retro spective analysis was conducted on the routine laboratory results of 242 patients with HBV-related cirrhosis and variceal bleeding,who were hospitalized between January 2018 and February 2024 at the Tenth People's Hospital Affiliated to Tongji University and the Minhang Hospital of Fudan University.The MLR and SII were calculated,and Cox regression models were used to determine the predictive factors for overall survival(OS)and rebleeding.These markers were combined with clinical parameters to construct a nomogram for risk stratification of such patients.Results:Multivariate analysis showed that an elevated MLR was independently associated with reduced OS(HR=5.10,P=0.002),while a higher SII predicted an increased risk of rebleeding(HR=1.23,P<0.001).The OS nomogram stratified patients into different risk groups,with 3-year OS rate ranging from 94.5%in the low-risk group to 58.7%in the high-risk group.The rebleeding nomogram identified 3-year rebleeding rates of 22.8%for the low-risk group and 62.3%for the high-risk group.Conclusion:MLR and SII,as cost-effective and easily obtainable predictive tools,provide useful references for individualized risk assessment for patients with HBV-related cirrhosis and variceal bleeding through the nomograms they construct.
作者
袁涛
何晨翔
黄晟宇
胡裕恒
陈炜
李俊
YUAN Tao;HE Chenxiang;HUANG Shengyu;HU Yuheng;CHEN Wei;LI Jun(Medical College,Anhui University of Science and Technology,Anhui 232001;Department of Hepatobiliary and Pancreatic Surgery,the Tenth People's Hospital Affiliated to Tongji University;Department of Gastroenterology,Minhang Hospital,Fudan University)
出处
《南通大学学报(医学版)》
2025年第3期222-230,共9页
Journal of Nantong University(Medical sciences)
基金
上海市科学技术委员会医学创新研究项目(23Y11905900)
安徽省自然科学基金资助项目(2308085MH270)
中央高校基本科研业务费专项资金(22120220606)
上海市第十人民医院研究型医师项目(2023YJXYSA008)
中国肝炎防治基金中西医结合肝病研究基金项目(YGFK20210053)
闵行区公共卫生重点学科建设项目(MGWXK2023-05)。
