摘要
目的探讨肝硬化食管胃静脉曲张破裂出血(EVB)患者内镜治疗后再出血的危险因素,并构建风险预测模型。方法选取2023年1月至2024年10月在南京医科大学第一附属医院接受内镜治疗的肝硬化EVB患者206例,随访6个月后,根据是否发生再出血分为再出血组(49例)和非再出血组(157例)。比较两组一般临床资料;采用多因素Logistic逐步回归分析肝硬化EVB患者内镜治疗后再出血的影响因素,构建肝硬化EVB患者内镜治疗后再出血的列线图模型并进行验证。结果再出血组Child-Pugh分级C级、红色征、曲张静脉直径、门静脉内径、脾静脉内径高于非再出血组,血红蛋白、血小板计数、血钠、白蛋白水平低于非再出血组,差异有统计学意义(P<0.05)。多因素Logistic逐步回归分析显示,Child-Pugh分级C级、有红色征、曲张静脉直径≥5.46 mm、门静脉内径≥13.17 mm是肝硬化EVB患者内镜治疗后再出血的危险因素,血钠是肝硬化EVB患者内镜治疗后再出血的保护因素(OR=2.356,95%CI:1.598~3.473,P<0.001;OR=2.158,95%CI:1.501~3.101,P<0.001;OR=2.489,95%CI:1.656~3.742,P<0.001;OR=2.729,95%CI:1.798~4.143,P<0.001;OR=0.442,95%CI:0.301~0.649,P<0.001)。列线图模型预测肝硬化EVB患者内镜治疗后再出血的AUC为0.902(95%CI:0.849~0.955),特异度为68.47%,敏感度为92.05%。结论肝硬化EVB患者首次内镜治疗后再出血的影响因素包括Child-Pugh分级、红色征、曲张静脉直径、门静脉内径、血钠,以此构建的列线图模型在预测再出血方面具有较高的应用价值。
Objective To investigate the risk factors for rebleeding after endoscopic treatment in patients with cirrhotic esophagogastric variceal bleeding(EVB)and to construct a risk prediction model.Methods A total of 206 cirrhotic EVB patients who received endoscopic treatment at the First Affiliated Hospital of Nanjing Medical University from January 2023 to October 2024 were enrolled.After 6 months of follow-up,they were divided into a rebleeding group(49 cases)and a non-rebleeding group(157 cases).General clinical data were compared between groups.Multivariate Logistic stepwise regression analysis was used to identify influencing factors for rebleeding after endoscopic treatment,and a nomogram model was constructed and validated.Results The rebleeding group showed higher rates of Child-Pugh grade C,presence of red color signs,larger diameters of variceal veins,portal veins,and splenic veins compared to the non-rebleeding group,hemoglobin,platelet count,serum sodium,and albumin levels were lower in the rebleeding group(P<0.05).Multivariate Logistic stepwise regression analysis identified Child-Pugh grade C(OR=2.356,95%CI:1.598-3.473),red color signs(OR=2.158,95%CI:1.501-3.101),variceal vein diameter≥5.46 mm(OR=2.489,95%CI:1.656-3.742),and portal vein diameter≥13.17 mm(OR=2.729,95%CI:1.798-4.143)as risk factors for rebleeding(all P<0.001),and serum sodium was a protective factor(OR=0.442,95%CI:0.301-0.649,P<0.001).The nomogram model achieved an AUC of 0.902(95%CI:0.849-0.955)for predicting rebleeding,with 68.47%specificity and 92.05%sensitivity.Conclusion Child-Pugh grading,red color signs,variceal vein diameter,portal vein diameter,and serum sodium influence rebleeding after initial endoscopic treatment in cirrhotic EVB patients.The constructed nomogram model demonstrates high predictive value for rebleeding.
作者
丁静
朱宏
陈莉
陈曦
张道权
祝正慧
杨延清
DING Jing;ZHU Hong;CHEN Li;CHEN Xi;ZHANG Daoquan;ZHU Zhenghui;YANG Yanqing(Department of Gastroenterology Endoscopy Center,The First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital),Nanjing,Jiangsu 210029,China;Department of Gastroenterology,The First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital),Nanjing,Jiangsu 210029,China)
出处
《转化医学杂志》
2025年第7期84-89,共6页
Translational Medicine Journal
基金
2024年江苏省干部保健科研立项项目(BJ24001)。
关键词
肝硬化
食管胃底静脉曲张
再出血
列线图
Liver cirrhosis
Esophageal and gastric varices
Rebleeding
Nomogram
