内镜下套扎治疗乙型肝炎肝硬化并发食管胃静脉曲张破裂出血患者1年内再出血调查及危险因素分析*

doi:10.3969/j.issn.1672-5069.2023.04.022

摘要/Abstract

摘要： 目的探讨采用内镜下食管静脉曲张套扎术(EVL)治疗后1年内乙型肝炎肝硬化(LC)并发食管胃静脉曲张(EV)破裂出血(EVB)患者再出血情况及其危险因素。方法 2018年3月～2021年3月我院收治的LC并发EVB患者122例,均行EVL治疗。所有患者均随访1年。应用Logistic回归分析预示再出血的危险因素,并建立预测模型,应用受试者工作特征曲线(ROC)分析该模型预测再出血的效能。结果在随访的1年里,治疗后122例患者发生再出血33例(27.0%);再出血组腹水、肝性脑病、自发性细菌性腹膜炎(SBP)和重度EV发生率分别为36.4%、12.1%、15.2%和75.8%,均显著大于未再出血组(分别为16.9%、2.2%、4.5%和48.3%,P<0.05),门静脉内径为(1.5±0.2)cm,显著宽于未再出血组【(1.1±0.2)cm,P<0.05】;多因素分析显示,发生腹水【OR(95%CI)=1.818(1.193～2.772)】、门静脉内径宽【OR(95%CI)=2.085(1.207～3.603)】、肝性脑病【OR(95%CI)=2.264(1.252～4.092)】、重度EV【OR(95%CI)=1.863(1.294～2.682)】和发生SBP【OR(95%CI)=1.784(1.173～2.714)】是影响EVL治疗后再出血的危险因素(P<0.05);根据多元Logistic回归分析结果,建立再出血风险预测模型,P=1/【1+e^{(0.538X腹水+0.735X门静脉内径+0.817X肝性脑病+0.622XEV程度+0.579XSBP-1.053)}】,经Hosmer-Lemeshow检验显示该预测模型与观测值拟合度较好(x²=8.361,P=0.399);经ROC曲线分析显示,该预测模型预测LC并发EVB患者再出血的AUC为0.899,95%CI:0.832～0.967,其敏感度为87.9%,特异度为86.5%。结论有并发症和重度EV患者在EVL治疗LC并发EVB患者后存在再出血的风险很大,需要给予积极的预防和治疗。

关键词: 肝硬化, 食管胃静脉曲张破裂出血, 内镜下食管静脉曲张套扎术, 再出血, 危险因素

Abstract: Objective The aim of this study was to investigate the risk factors of re-bleeding after endoscopic esophageal varix ligation (EVL) in the treatment of patients with hepatitis B liver cirrhosis (LC) and esophagogastric varices (EV) bleeding (EVB). Methods 122 patients with LC complicated by EVB were encountered in our hospital between March 2018 and March 2021, and they were all treated with EVL. All patients were followed-up for 1 year. The risk factors was analyzed by multivariate Logistic regression, a predictive model for re-bleeding was established and its predictive efficacy was evaluated by the area under the receiver operating characteristic curve (AUROC). Results At the end of one-year follow-up, the re-bleeding rate in the 122 patients was 27.0%; the incidences of ascites, hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP), severe EV in patients with re-bleeding were 36.4%, 12.1%, 15.2% and 75.8%, all significantly higher than 16.9%, 2.2%, 4.5% and 48.3%, P<0.05), while the portal vein diameter was (1.5±0.2)cm, much wider than [(1.1±0.2)cm, P<0.05] in patients without re-bleeding; the multivariate Logistic analysis showed that the ascites [OR(95%CI)=1.818(1.193-2.772)], portal vain diameter [OR(95%CI)=2.085(1.207-3.603)], HE [OR(95%CI)=2.264(1.252-4.092)], severe EV[OR(95%CI)=1.863(1.294-2.682)] and SBP [OR(95%CI)=1.784(1.173-2.714)] were the impacting risk factors for re-bleeding (P<0.05); the formula, e.g., P=1/[1+e^{(0.538Xascites+0.735Xportal vain+0.817XHE+0.622XEV+0.579XSBP-1.053)}] was established based on the Logistic analysis, which had a very good R-squared with the observed data by Hosmer-Lemeshow test(x²=8.361, P=0.399); the ROC analysis showed that the AUC was 0.899, 95%CI:0.832-0.967, with the sensitivity of 87.9%, and the specificity of 86.5%, when the formula we established was applied to predict re-bleeding. Conclusion The patients with LC and EVB having complications and severe EV might have a high risk of re-bleeding after EVL, which should be intervened appropriately clinically with endoscopic measures and/or medicines.

Key words: Liver cirrhosis, Esophagogastric varices bleeding, Endoscopic esophageal varix ligation, Re-bleeding, Risk factors

吴冲, 张小丽, 邢益门, 周婷. 内镜下套扎治疗乙型肝炎肝硬化并发食管胃静脉曲张破裂出血患者1年内再出血调查及危险因素分析^*[J]. 实用肝脏病杂志, 2023, 26(4): 540-543.

Wu Chong, Zhang Xiaoli, Xing Yimen, et al. Risk factors of re-bleeding after endoscopic esophageal varix ligation in patients with hepatitis B liver cirrhosis and esophagogastric varices bleeding[J]. Journal of Practical Hepatology, 2023, 26(4): 540-543.

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内镜下套扎治疗乙型肝炎肝硬化并发食管胃静脉曲张破裂出血患者1年内再出血调查及危险因素分析^*

Risk factors of re-bleeding after endoscopic esophageal varix ligation in patients with hepatitis B liver cirrhosis and esophagogastric varices bleeding

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