肝硬化上消化道出血患者预后的列线图预测模型构建-现代医学

肝硬化上消化道出血患者预后的列线图预测模型构建

单位：石家庄平安医院重症医学科, 河北石家庄 050000

分类号：R573.2;R575.2

出版年·卷·期（页码）：2023·51·第三期（289-294）

摘要：

目的：构建预测肝硬化上消化道出血(UGH)患者预后的列线图模型，并检验其预测效能。方法：回顾性分析2017年4月至2022年4月本院收治的435例肝硬化UGH患者的临床资料，根据治疗后1个月内生存情况分成生存组和死亡组。对两组行单因素分析及Logistic回归分析，确定其影响因素后构建列线图模型，并通过受试者工作特征(ROC)曲线下面积(AUC)和H-L拟合优度对模型的区分度和精准度予以验证。结果：435例患者中，49例死亡，生存386例；生存组和死亡组出血原因、出血量、治疗后72 h内再出血比例、Child-Pugh分级、并发肝性脑病比例、血清白蛋白水平比较差异有统计学意义(P＜0.05)；Logistic回归分析结果显示，肝硬化UGH患者预后的影响因素主要有食管胃底静脉曲张(EGV)、出血量≥500 ml、治疗后72 h内再出血、Child-Pugh分级为C级、并发肝性脑病等5项(P＜0.05)；ROC曲线分析结果显示，构建的预测肝硬化UGH患者预后的列线图模型区分度(AUC为0.778，95%CI 0.709~0.848)及精准度(拟合优度H-L检验χ²=7.136，P=0.539)较高。结论：基于EGV、出血量≥500 ml、治疗后72 h内再出血、Child-Pugh分级为C级、并发肝性脑病等5项因素构建的列线图预测模型可较好地预测肝硬化UGH患者预后。

Objective： To construct a nomogram model for predicting the prognosis of patients with liver cirrhosis upper gastrointestinal hemorrhage (UGH), and to test its predictive performance. Methods： The clinical data of 435 patients with liver cirrhosis UGH admitted to our hospital from April 2017 to April 2022 were retrospectively analyzed, and they were divided into survival group and death group according to the survival condition within 1 month after treatment. The univariate analysis and Logistic regression analysis of the two groups were conducted, the nomogram model was established after determining the influencing factors, and the differentiation and accuracy of the model were verified by the area under receiver operating characteristic curve (AUC) and H-L goodness of fit. Results： Among 435 patients, 49 died and 386 survived; there were obvious differences in the cause of bleeding, the amount of bleeding, the proportion of rebleeding within 72 hours after treatment, the Child-Pugh classification, the proportion of complicated hepatic encephalopathy, and the level of serum albuminbetween the survival group and the death group (P<0.05); Logistic regression analysis showed that the prognostic factors of patients with liver cirrhosis UGH mainly included esophagealand gastric varices(EGV), bleeding volume ≥500 ml, rebleeding within 72 hours after treatment, Child-Pugh grade of grade C, complicated with hepatic encephalopathy (P<0.05); the receiver operating characteristic curve analysis results showed that the constructed nomogram model for predicting the prognosis of patients with liver cirrhosis UGH had higher discrimination (AUC=0.778, 95%CI 0.709-0.848) and accuracy (H-L test χ²=7.136, P=0.539). Conclusion： The nomogram prediction model constructed based on five factors including EGV, bleeding volume ≥500 ml, rebleeding within 72 hours after treatment, Child-Pugh grade of grade C, and complicated with hepatic encephalopathy can better predict the prognosis of patients with liver cirrhosis UGH.

参考文献：

[1] DIAS E,AZEVEDO F,AFONSO A,et al.Upper gastrointestinal bleeding in a patient with liver cirrhosis:gastroesophageal varices are not always to blame[J].J Gastrointestin Liver Dis,2021,30(3):323.
[2] 刘小娟,文武.内镜治疗非静脉曲张性上消化道出血的临床效果及安全性分析[J].现代医学,2020,48(3):325-328.
[3] 刘君.Child-Pugh与Rockall评分评估肝硬化失代偿期患者上消化道出血预后比较[J].中西医结合肝病杂志,2019,29(6):562-563.
[4] TANG M,WANG H,CAO Y,et al.Nomogram for predicting occurrence and prognosis of liver metastasis in colorectal cancer:a population-based study[J].Int J Colorectal Dis,2021,36(2):271-282.
[5] 中华医学会肝病学分会和感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].实用肝脏病杂志,2011,14(2):81-89.
[6] 张宁,谢元元.肝硬化患者血小板参数、门静脉宽度及凝血功能与上消化道出血关系的相关探讨[J].血栓与止血学,2021,27(5):801-802.
[7] ROBERTSON M,NG J,ABU SHAWISH W,et al.Risk stratification in acute variceal bleeding:comparison of the AIMS65 score to established upper gastrointestinal bleeding and liver disease severity risk stratification scoring systems in predicting mortality and rebleeding[J].Dig Endosc,2020,32(5):761-768.
[8] 杨熹,宋冬梅,华敏.生长抑素联合奥曲肽治疗肝硬化并发上消化道出血患者疗效及其对凝血功能指标的影响再观察[J].实用肝脏病杂志,2020,23(5):695-698.
[9] 范红顺,熊志娇,马超,等.肝硬化患者并发上消化道出血的风险因素及预后因素分析[J].解放军预防医学杂志,2019,37(2):16-18.
[10] 常宇飞,刘晓,高越,等.肝硬化门静脉高压并发上消化道出血的影响因素分析[J].血管与腔内血管外科杂志,2021,7(10):1222-1226.
[11] 李志英.肝硬化门静脉血栓患者并发上消化道出血危险因素与预后的影响因素分析[J].中国医学创新,2019,16(32):54-58.
[12] STERPETTI A V,KAPPES S K.Cirrhosis and bleeding esophageal varices:historic perspectives[J].J Gastrointest Surg,2020,24(8):1929-1936.
[13] FUKUDA S,SHIMODAIRA Y,WATANABE K,et al.Risks for rebleeding and in-hospital mortality after gastrointestinal bleeding in a tertiary referral center in Japan[J].Digestion,2020,101(1):31-37.
[14] 赵艳,赵倩,任牡丹,等.肝硬化合并急性上消化道出血的预后评分系统对比[J].现代消化及介入诊疗,2021,26(2):158-162.
[15] WOLTER K,PRAKTIKNJO M,BOIE J,et al.Glue embolization of gastroesophageal varices during transjugular intrahepatic portosystemic shunt (TIPS) improves survival compared to coil-only embolization-a single-center retrospective study[J].Cardiovasc Intervent Radiol,2021,44(8):1240-1250.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录