内镜下组织胶注射和/或曲张静脉套扎术治疗肝硬化并发食管胃静脉曲张破裂出血患者疗效研究*

doi:10.3969/j.issn.1672-5069.2026.05.016

摘要/Abstract

摘要： 目的探讨内镜治疗肝硬化并发食管胃静脉曲张破裂出血(EGVB)患者的疗效以及血清纤维蛋白原-白蛋白比值(FAR)、外周血中性粒细胞计数-淋巴细胞计数比值(NLR)联合血小板计数/脾长径比值(PC/SD)预测治疗后再出血的价值。方法 2021年12月～2024年12月我院收治的肝硬化并发EGVB患者86例,采用内镜下组织胶注射和/或曲张静脉套扎术(EVL)治疗,随访1年,记录再出血情况。常规临床检测和检查,计算FAR、NLR和PC/SD比值。结果随访12个月,在86例接受内镜治疗的肝硬化并发EGVB患者中发生再出血37例(43.0%);再出血组Child-Pugh C级占比、INR、FAR和NLR水平分别为100.0%、(1.4±0.2)、(0.05±0.01)和3.8(2.6,7.4),均显著高于或大于未再出血组【分别为42.9%、(1.2±0.1)、(0.03±0.01)和2.2(1.6,5.3),P<0.05】,而PC/SD比值为428.3(338.4,568.5),显著低于未再出血组【786.3(382.5,1028.8),P<0.05】;多因素Logistic回归分析显示,PC/SD比值(OR=0.532,95%CI:0.369~0.765)为肝硬化并发EGVB患者内镜治疗后再出血的保护因素(P<0.05),而Child-Pugh分级(OR=3.710,95%CI:1.267~10.860)、INR(OR=5.631,95%CI:2.088~15.185)、FAR(OR=2.358,95%CI:1.262~4.407)和NLR(OR=1.619,95%CI:1.167~2.246)为独立的危险因素(P<0.05);ROC分析显示,FAR和NLR联合PC/SD比值预测肝硬化并发EGVB患者内镜治疗后再出血的AUC为0.929(95%CI:0.869~0.989),显著高于FAR、NLR或PC/SD比值单独预测【AUC=0.760(95%CI:0.656~0.864)、AUC=0.822(95%CI:0.735~0.908)或AUC=0.777(95%CI:0.675~0.860),P<0.05】,联合预测的敏感度为89.2%,特异度为89.8%。结论 FAR、NLR联合PC/SD可用于预测肝硬化并发EGVB患者内镜治疗后再出血的发生,具有一定的临床应用价值。

关键词: 肝硬化, 食管胃静脉曲张破裂出血, 内镜下组织胶注射, 曲张静脉套扎术, 再出血, 预测

Abstract: Objective The aim of this study was to investigate endoscopic glue injection and/or esophageal variceal ligation (EVL) in the treatment of patients with liver cirrhosis complicated with esophageal and gastric variceal bleeding (EGVB). Methods 86 patients with liver cirrhosis complicated with EGVB were encountered in our hospital between December 2021 and December 2024, and all were treated with endoscopic tissue glue injection and/or EVL. After 1 year of follow-up, the rebleeding was recorded. Routine clinical tests and examinations were performed to calculate fibrinogen-to-albumin ratio (FAR), neutrophil-to-lymphocyte ratio (NLR) and platelet count/spleen length diameter ratio (PC/SD). Results By end of 12 months of follow-up, rebleeding occurred in 37 cases (43.0%) in the 86 patients with liver cirrhosis after endoscopic treatment; percentage of Child-Pugh class C, INR, FAR and NLR in patients with re-bleeding were 100.0%, (1.4±0.2), (0.05±0.01) and 3.8(2.6,7.4), all significantly higher or greater than [42.9%, (1.2±0.1), (0.03±0.01) and 2.2(1.6,5.3),respectively, P<0.05],while PC/SD ratio was 428.3(338.4,568.5),significantly lower than [786.3(382.5,1028.8),P<0.05] in those without re-bleeding;multivariate Logistic regression analysis showed that PC/SD ratio (OR=0.532,95%CI:0.369-0.765) was protective factor for(P<0.05),while Child-Pugh class (OR=3.710,95%CI:1.267-10.860), INR(OR=5.631,95%CI:2.088-15.185), FAR(OR=2.358,95%CI:1.262-4.407) and NLR(OR=1.619,95%CI:1.167-2.246) were independent risk factors for re-bleeding in patients with EGVB after endoscopic treatment (P<0.05);ROC analysis demonstrated that the AUC was 0.929(95%CI:0.869-0.989), with sensitivity of 89.2% and specificity of 89.8%, when FAR was combined with NLR and PC/SD ratio in predicting re-bleeding. Conclusion Utility of FAR, NLR and PC/SD ratio combination has to some extent clinical value in predicting rebleeding in patients with liver cirrhosis complicated with EGVB after endoscopic treatment, which needs further investigation.

Key words: Liver cirrhosis, Esophageal and gastric variceal bleeding, Endoscopic glue injection, Esophageal variceal ligation, Re-bleeding, Prediction

黄寅, 莫军, 庄贤锐, 孙士钊, 曹海丹. 内镜下组织胶注射和/或曲张静脉套扎术治疗肝硬化并发食管胃静脉曲张破裂出血患者疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(5): 701-704.

Huang Yin, Mo Jun, Zhuang Xianrui, et al. Endoscopic glue injection and/or esophageal variceal ligation in the treatment of patients with liver cirrhosis complicated with esophageal and gastric variceal bleeding[J]. Journal of Practical Hepatology, 2026, 29(5): 701-704.

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内镜下组织胶注射和/或曲张静脉套扎术治疗肝硬化并发食管胃静脉曲张破裂出血患者疗效研究^*

Endoscopic glue injection and/or esophageal variceal ligation in the treatment of patients with liver cirrhosis complicated with esophageal and gastric variceal bleeding

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