PAR联合Charlson指数预测药物治疗的肝硬化并发食管静脉曲张破裂出血患者再出血风险价值研究*

doi:10.3969/j.issn.1672-5069.2025.04.026

摘要/Abstract

摘要： 目的研究血小板与白蛋白比值(PAR)联合Charlson指数预测肝硬化并发食管静脉曲张破裂出血(EVB)患者治疗后再出血风险的价值。方法 2021年5月～2024年6月我院诊治的肝硬化并发EVB患者119例,给予止血、输血、生长抑素和奥美拉唑治疗,再给予卡维地洛维持治疗,随访6个月。常规临床检测和检查,计算PAR,应用评分量表评估Charlson指数,使用Siremuller设备测量和计算肝静脉压力梯度(HVPG)。应用二元Logistic回归分析影响再出血的因素,绘制受试者工作特征曲线(ROC)分析预测效能。结果随访6个月时,119例EVB患者发生再出血41例(34.5%);再出血组血小板计数和PAR分别为(53.4±5.6)×10⁹/L和(1.8±0.2),均显著低于未再出血组【分别为(68.9±7.3)×10⁹/L和(2.3±0.4),P<0.05】,血清D-二聚体、Charlson指数、HVPG、门静脉内径、脾静脉内径和静脉曲张G3级占比分别为(2.7±0.3)g/L、(2.6±0.3)分、(20.3±2.6)mmHg、(16.3±1.7)mm、(10.5±1.4)mm和78.0%,均显著高于未再出血组【分别为(1.4±0.2)g/L、(2.0±0.4)分、(16.2±1.8)mmHg、(14.6±1.8)mm、(8.8±0.9)mm和42.3%,P<0.05】;Logistic回归分析显示,PAR为影响肝硬化并发EVB患者药物治疗后再出血的保护因素(OR=0.562,95%CI:0.397～0.797,P<0.05),而Charlson指数(OR=1.587,95%CI:1.064～2.368)、HVPG(OR=1.464,95%CI:1.072～1.999)和EV分级(OR=1.647,95%CI:1.041～2.606,P<0.05)为独立危险因素;ROC分析显示,PAR联合Charlson指数预测再出血的AUC为0.889(95%CI:0.838～0.939),显著高于PAR【AUC=0.804(95%CI:0.747～0.861)或Charlson指数单独预测【AUC=0.790(95%CI:0.725～0.855),P<0.05】。结论 PAR联合Charlson指数预测肝硬化并发EVB患者治疗后再出血有一定的临床应用价值,对重点人群应给予必要的干预措施。

关键词: 肝硬化, 食管静脉曲张破裂出血, 血小板与白蛋白比值, Charlson指数, 再出血, 预测

Abstract: Objective The aim of this study was to investigate prediction of re-bleeding by platelet-to-albumin ratio (PAR) and Charlson comorbidity indexin cirrhotics with esophageal variceal bleeding (EVB) after first hemostasis. Methods 119 patients with EVB arisen from liver cirrhosiswere encountered in our hospital between May 2021 and June 2024, all received somatostatin and omeprazole therapy for emergent hemostasis at base of comprehensive supporting measurement and oral carvedilol maintenance thereafter, and were followed-up for six months. PAR and Charlson index were routinely obtained clinically, and hepatic vein pressure gradient (HVPG) was detected and calculated by Siremuller special equipment. Multivariate Logistic regression analysis was conducted to screen risk factors for re-bleeding, and receiver operating characteristic curve (ROC) was applied to analyze predicting performance. Results By end of 6 months, re-bleeding occurred in 41cases (34.5%) out of the 119 patients; platelet count and PAR in the re-bleeding group were (53.4±5.6)×10⁹/L and (1.8±0.2), both much lower than [(68.9±7.3)×10⁹/L and (2.3±0.4),P<0.05], while serum D-dimer, Charlson index, HVPG, portal vein diameter, splenic vein diameter and percentage of G3 EV were (2.7±0.3)g/L, (2.6±0.3),(20.3±2.6)mmHg, (16.3±1.7)mm,(10.5±1.4)mm and 78.0%, all significantly higher than [(1.4±0.2)g/L, (2.0±0.4),(16.2±1.8)mmHg, (14.6±1.8)mm, (8.8±0.9)mm and 42.3%, respectively, P<0.05] in non-re-bleeding group; Logistic regression analysis showed that PAR was protecting factor (OR=0.562, 95%CI:0.397-0.797,P<0.05), while Charlson index (OR=1.587, 95%CI: 1.064-2.368),HVPG(OR=1.464, 95%CI:1.072-1.999)and EV grading (OR=1.647, 95%CI:1.041-2.606, P<0.05) were all the independent risk factors;ROC analysis demonstrated that the AUC was 0.889(95%CI:0.838-0.939) when PAR was combined Charlson index in predicting re-bleeding, much superior to PAR[AUC=0.804(95%CI:0.747-0.861) by PAR or Charlson index [AUC=0.790(95%CI:0.725-0.855), P<0.05] alone. Conclusion The combination of PAR and Charlson index has to some extent predicting performance of re-bleeding in patients with EVB after first hemostasis.

Key words: Liver cirrhosis, Esophageal varicealbleeding, Platelet-to-albumin ratio, Charlson index, due, Re-bleeding, Prediction

徐凤华, 彭乐, 徐宁. PAR联合Charlson指数预测药物治疗的肝硬化并发食管静脉曲张破裂出血患者再出血风险价值研究^*[J]. 实用肝脏病杂志, 2025, 28(4): 581-584.

Xu Fenghua, Peng Le, Xu Ning. Prediction of re-bleeding by platelet-to-albumin ratio and Charlson comorbidity index in cirrhotics with esophageal variceal bleeding after first hemostasis[J]. Journal of Practical Hepatology, 2025, 28(4): 581-584.

参考文献

[1] 程洋,张峰,王曦旋,等. 普萘洛尔与卡维地洛预防肝硬化患者并发食管胃静脉曲张破裂出血临床疗效比较. 实用肝脏病杂志,2023,26(2):254-257.
[2] Hu XG, Dai JJ, Lu J, et al. Efficacy of transjugular intrahepatic portosystemic shunts in treating cirrhotic esophageal-gastric variceal bleeding.World J Gastrointest Surg, 2024, 16(2):471-480.
[3] Tevethia HV, Pande A, Vijayaraghavan R,et al.Combination of carvedilol with variceal band ligation in prevention of first variceal bleed in Child-Turcotte-Pugh B and C cirrhosis with high-risk oesophageal varices: the 'CAVARLY TRIAL'. Gut, 2024, 73(11):1844-1853.
[4] 原姗姗,刘家铭,庄坤,等. 内镜下食管静脉曲张套扎联合卡维地洛或普萘洛尔治疗肝硬化食管静脉曲张再出血的随机对照研究. 中国医药,2022,17(1):68-71.
[5] Ma H, Chen J, Zhan X,et al. Platelet-to-albumin ratio:a potential biomarker for predicting all-cause and cardiovascular mortality in patients undergoing peritoneal dialysis.BMC Nephrol, 2024, 25(1):365.
[6] 陈声辉,姚思思,余明. Charlson合并症指数对低位直肠癌根治术患者预后的预测价值. 癌症进展,2024,22(5):536-539.
[7] Gralnek IM, Camus Duboc M, Garcia-Pagan JC,et al. Endoscopic diagnosis and management of esophagogastric variceal hemorrhage:European society of gastrointestinal endoscopy (ESGE) guideline.Endoscopy, 2022, 54(11):1094-1120.
[8] 吕梦甜,孙菊,刘文宾, 等.查尔森合并症指数对重型再生障碍性贫血患者的预后价值. 中华危重症医学杂志(电子版), 2020, 1(4):277-279.
[9] Fu S, Chen D, Zhang Z,et al. Predictive value of spectral computed tomography parameters in esophageal variceal rupture and bleeding in cirrhosis.Turk J Gastroenterol, 2023, 34(4):339-345.
[10] Liu C, Zhang L, Zhang S, Li X, et al. Carvedilol to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension stratified by liver stiffness:study protocol for a randomied, double-blind, placebo-controlled, multicentre trial in China. BMJ Open, 2024, 14(7):e081623.
[11] Xia R, Wu B, Zhou J,et al. Ascites affects the benefit of carvedilol on patients with liver cirrhosis and esophageal and gastric varices. Clin Transl Sci, 2024, 17(7):e13889.
[12] Yang TC, Chen WC, Hou MC,et al. Endoscopic variceal ligation versus propranolol for the primary prevention of oesophageal variceal bleeding in patients with hepatocellular carcinoma:an open-label, two-centre, randomised controlled trial.Gut, 2024, 73(4):682-690.
[13] 涂建军,方翔,蒋琪,等. 乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者再出血影响因素及预测模型的建立. 实用肝脏病杂志,2023,26(5):686-689.
[14] 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. 实用肝脏病杂志,2023,26(3):392-395.
[15] 贺庆娟,房英霞,刘旭臣,等. 肝硬化食管静脉曲张急诊套扎术后再出血的影响因素. 临床肝胆病杂志,2022,38(8):1801-1805.
[16] 胡建,姚运河,顾宇,等. 治疗前血小板与白蛋白比值对肝硬化伴食管和胃静脉曲张出血内镜治疗短期预后的预测价值. 中国医师进修杂志,2024,47(2):144-149.
[17] Gnanenthiran SR, Pennings GJ, Reddel CJ,et al. Identification of a distinct platelet phenotype in the elderly:ADP hypersensitivity coexists with platelet PAR (Protease-Activated Receptor)-1 and PAR-4-mediated thrombin resistance.Arterioscler Thromb Vasc Biol, 2022, 42(8):960-972.
[18] 蔡驰宇,王连才,陶连元,等. 年龄校正的Charlson合并症指数与肝门部胆管癌患者腹腔镜手术切除后预后的关系. 中华肝胆外科杂志,2024,30(1):33-37.
[19] Tarannum S, Ilyas T, Tarannum Shaik S,et al. Assessment of the Child-Pugh score, model for end-stage liver disease score, fibrosis-4 index, and AST to platelet ratio index as non-endoscopic predictors of the presence of esophageal varices and variceal bleeding in chronic liver disease patients.Cureus, 2024, 16(11):e73768.
[20] Narayanan P.PAR for the liver course: Preserving platelet function mitigates outcomes in cirrhosis.Hepatology, 2024, 80(5):991-992.

PAR联合Charlson指数预测药物治疗的肝硬化并发食管静脉曲张破裂出血患者再出血风险价值研究^*

Prediction of re-bleeding by platelet-to-albumin ratio and Charlson comorbidity index in cirrhotics with esophageal variceal bleeding after first hemostasis

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