首页|血清学指标联合Child-Pugh评分对肝硬化食管静脉曲张破裂出血患者EVL术后再出血的预测价值

血清学指标联合Child-Pugh评分对肝硬化食管静脉曲张破裂出血患者EVL术后再出血的预测价值

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目的 分析血清学指标联合Child-Pugh评分对肝硬化食管静脉曲张破裂出血患者食管静脉曲张套扎术(EVL)术后再出血的预测价值.方法 2020年9月-2022年9月右江民族医学院附属医院收治的肝硬化EVB行EVL治疗的患者97例,根据患者EVL术后6个月内是否发生再出血分为再出血组(n=31)和非再出血组(n=66),收集患者临床资料,采用多因素logistic回归分析影响肝硬化EVB患者EVL术后再出血的相关因素,采用受试者工作特征曲线(ROC)及曲线下面积(AUC)分析血清学指标联合Child-Pugh评分对肝硬化EVB患者EVL术后再出血的预测价值.结果 多因素logistic回归分析,结果显示,Child-Pugh分级(OR=2.259,95％CI:1.040～4.909)、门静脉内径(OR=2.93395％CI:1.509～5.700)、APTT(OR=1.451 95％CI:1.158～1.817)、PT(OR=1.982 95％CI:1.120～3.506)、Child-Pugh评分(OR=3.834 95％CI:1.849～7.950)是影响肝硬化EVB患者EVL术后再出血的危险因素,PLT(OR=0.58595％CI:0.369～0.927)、Alb(OR=0.824 95％CI:0.723～0.940)是影响肝硬化EVB患者EVL术后再出血的保护因素(P＜0.05);ROC曲线结果显示,PLT、APTT、PT、Alb、Child-Pugh评分以及各指标联合预测肝硬化EVB患者EVL术后再出血的 AUC 分别为 0.800、0.671、0.729、0.721、0.789 和 0.916,其敏感度分别为 83.9％、64.5％、71.0％、77.4％、80.6％和 87.1％,特异度分别为 63.6％、68.2％、75.8％、66.7％、65.2％和 74.2％.结论 Child-Pugh 分级、门静脉内径、PLT、APTT、PT、Alb、Child-Pugh评分是肝硬化EVB患者EVL术后再出血的影响因素,血清学指标PLT、APTT、PT、Alb联合Child-Pugh评分有助于提升对肝硬化EVB患者EVL术后再出血的预测价值.
Analysis of predictive value of serological indicators combined with Child-Pugh score on rebleeding after EVL in patients with liver cirrhosis complicated with esophageal varices bleeding
Objective To analyze the predictive value of serological indicators combined with Child-Pugh score on rebleeding after esophageal variceal ligation(EVL)in patients with liver cirrhosis complicated with esophageal varices bleeding(EVB).Methods 97 patients with liver cirrhosis and EVB who received EVL treatment in our hospital between September 2020 and September 2022 were enrolled,and divided into rebleeding group(n=31)and non-rebleeding group(n=66)according to whether rebleeding occurred within 6 months after EVL.Clinical data of patients were collected.Multivariate logistic regression analysis was used to analyze the related factors affecting rebleeding after EVL in patients with liver cirrhosis and EVB,and the predictive value of serological indicators combined with Child-Pugh score on rebleeding after EVL in patients with liver cirrhosis and EVB was analyzed by receiver operating characteristic curve(ROC)and area under the curve(AUC).Results Multivariate logistic regression analysis showed that Child-Pugh grading(OR=2.259,95％CI:1.040-4.909),portal vein diameter(OR=2.933,95％CI:1.509-5.700),APTT(OR=1.451,95％CI:1.1 58-1.817),PT(OR=1.982,95％CI:1.120-3.506)and Child-Pugh score(OR=3.834,95％CI:1.849-7.950)were the risk factors of rebleeding after EVL in patients with liver cirrhosis and EVB,and PLT(OR=0.585,95％CI:0.369-0.927)and Alb(OR=0.824,95％CI:0.723-0.940)were the protective factors effecting rebleeding after EVL in patients with liver cirrhosis and EVB(P＜0.05).The results of ROC showed that the AUCs of PLT,APTT,PT,Alb,Child-Pugh score and the combination of the above indicators in predicting rebleeding after EVL in patients with liver cirrhosis and EVB were 0.800,0.671,0.729,0.721,0.789 and 0.916 respectively,and the sensitivities were 83.9％,64.5％,71.0％,77.4％,80.6％and 87.1％,and the specificities were 63.6％,68.2％,75.8％,66.7％,65.2％and 74.2％respectively.Conclusion Child-Pugh grading,portal vein diameter,PLT,APTT,PT,Alb and Child-Pugh score are the influencing factors of rebleeding after EVL in patients with liver cirrhosis complicated with EVB.Serological indicators of PLT,APTT,PT and Alb combined with Child-Pugh score can help to enhance the predictive value on rebleeding after EVL in patients with liver cirrhosis complicated with EVB.

Serological indicatorsLiver cirrhosisEsophageal varices bleedingEsophageal variceal ligationRebleedingPredictive value

胡静、易庭庄、农欣蕾、王统华

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533000 广西百色 右江民族医学院附属医院消化内科

533000 广西百色 右江民族医学院附属医院肿瘤放疗科

533000 广西百色 右江民族医学院附属医院消化内镜室

血清学指标 肝硬化 食管静脉曲张破裂出血 食管静脉曲张套扎术 再出血 预测价值

广西自然科学基金项目

2020GXNSFAA297170

2024

肝脏
上海市医学会

肝脏

CSTPCD
影响因子：0.71
ISSN：1008-1704
年,卷(期)：2024.29(8)