血浆纤维蛋白原水平预测乙型肝炎肝硬化患者内镜治疗后食管胃静脉曲张再出血风险效能分析*

doi:10.3969/j.issn.1672-5069.2023.03.023

摘要/Abstract

摘要： 目的探讨血浆纤维蛋白原水平预测内镜下治疗的乙型肝炎肝硬化并发食管胃静脉曲张破裂出血(EVB)患者再出血的效能。方法 2013年～2017年我院诊治的乙型肝炎肝硬化并发EVB的住院患者,均接受内镜下组织胶注射和/或曲张静脉套扎术治疗,术后随访1年。应用首次入院时血浆纤维蛋白原水平,经ROC曲线分析选取截断点,将患者分为血浆高水平和低水平纤维蛋白原组,比较两组基线资料特点。应用Kaplan-Meier曲线比较两组患者内镜治疗后1 a再出血率。采用Cox单因素和多因素回归分析影响内镜治疗后再出血的危险因素。结果在纳入255例乙型肝炎肝硬化并发EVB并接受内镜治疗患者,经ROC曲线分析选择150 mg/dL作为截断点,将患者分为血浆高纤维蛋白原组156和低纤维蛋白原组99;低纤维蛋白组Child-Pugh评分显著高于高纤维蛋白组,血小板水平更低,凝血酶原时间更长,1 a再出血率显著高于高纤维蛋白原组(25.3%对10.9%);在合并门静脉血栓的患者中这种差异更为显著(45.2%对11.3%,P=0.0002);经Cox单因素和多因素分析,在权衡年龄、合并门静脉血栓和合并糖尿病之后,低纤维蛋白原组内镜治疗后1 a再出血的风险是高纤维蛋白原组的3.37倍(95%CI:1.78～6.36,P<0.001)。结论血浆低纤维蛋白原水平将增加内镜治疗后EVB患者再出血的风险,在合并门静脉血栓的患者更为显著。在内镜治疗后检测血浆纤维蛋白原,将有利于预测再出血风险,而应给予必要的干预措施。

关键词: 肝硬化, 门静脉高压, 食管胃静脉曲张破裂出血, 纤维蛋白原, 内镜下治疗, 再出血

Abstract: Objective This study aimed to investigate whether plasma fibrinogen levels affects gastroesophageal variceal rebleeding in patients with hepatitis B-induced liver cirrhosis after endoscopic treatment. Methods The patients with hepatitis B-induced liver cirrhosis and a history of gastroesophageal variceal bleeding (EVB) were encountered in Zhongshan Hospital between 2013 and 2017, and all the patients received endoscopic sandwich tissue glue injection and varicose vein ligation treatment. Based on plasma fibrinogen levels of 150 mg/dL as the cut-off-value, the patients were divided into high and low level groups. The baseline data were analyzed by ROC curve, and the Kaplan-Meier analysis was applied to compare the rebleeding rate between the two groups. The univariate and multivariate cox regression analyzes were conducted to identify the independent prognostic factors of rebleeding after endoscopic treatment. Result A total of 255 patients with liver cirrhosis and EVB history were included; the patients with low plasma fibrinogen level had significantly higher Child-Pugh score and lower platelet count (P<0.05); the Kaplan-Meier analysis showed that the patients with low fibrinogen level had a significantly higher rebleeding rate compared to those with high fibrinogen level within 1 year after endoscopic treatment (25.3% vs, 10.9%, P=0.0016), which was more pronounced in the subgroup with portal vein thrombosis compared to those without (45.2% vs, 11.3%, P=0.0002); the multivariate analysis demonstrated that the elderly patients, those with portal vein thrombosis, with diabetes mellitus or low plasma fibrinogen level (<150 mg/dL) were the independent prognostic factors for gastroesophageal variceal rebleeding. Conclusion The low plasma fibrinogen level could predict higher rebleeding risk within 1 year after endoscopic treatment in patients with EVB. The surveillance of plasma fibrinogen levels after endoscopic treatment might be guide clinical management.

Key words: Liver cirrhosis, Portal hypertension, Gastroesophageal variceal bleeding, Fibrinogen, Endoscopic treatment, re-bleeding

叶丝陶, 黄晓铨, 陈世耀. 血浆纤维蛋白原水平预测乙型肝炎肝硬化患者内镜治疗后食管胃静脉曲张再出血风险效能分析^*[J]. 实用肝脏病杂志, 2023, 26(3): 392-395.

Ye Sitao, Huang Xiaoquan, Chen Shiyao. Plasma fibrinogen level predicts gastroesophageal variceal rebleeding in patients with hepatitis B-induced liver cirrhosis after endoscopic treatment[J]. Journal of Practical Hepatology, 2023, 26(3): 392-395.

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血浆纤维蛋白原水平预测乙型肝炎肝硬化患者内镜治疗后食管胃静脉曲张再出血风险效能分析^*

Plasma fibrinogen level predicts gastroesophageal variceal rebleeding in patients with hepatitis B-induced liver cirrhosis after endoscopic treatment

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