摘要
目的探究肝硬化合并食管胃底静脉曲张(EGV)患者发生破裂出血的相关危险因素。方法纳入309名EGV患者,根据其住院期间是否发生EGV破裂出血,分为出血组(n=62)和非出血组(n=247),收集患者的一般特征、实验室及影像学资料并进行统计分析。连续变量应用Mann-Whitney U检验或t检验,分类变量应用χ2分析探究组间差异,应用二元Logistic回归探究EGV破裂出血的危险因素并构建预测模型。将上述患者按照7∶3分为建模组及验证组,应用bootstrap法进行内部验证,应用ROC曲线对两组模型效能予以检验。结果高密度脂蛋白(HDL)(P<0.001,OR=0.131,95%CI=0.049~0.350)、C-反应蛋白(CRP)(P=0.010,OR=2.657,95%CI=1.269~5.563)、门静脉宽度(PVW)(P=0.050,OR=1.156,95%CI=1.000~1.336)、脾脏厚度(P=0.035,OR=1.492,95%CI=1.028~2.165)、Child-Pugh B级(P=0.003,OR=11.320,95%CI=2.232~57.407)及Child-Pugh C级(P=0.002,OR=3.888,95%CI=1.659~9.114)与EGV破裂出血相关,ROC曲线示建模组集预测模型的AUC值为0.802,验证组为0.836。结论CRP升高、Child-Pugh B级和C级、HDL降低、门静脉增宽和脾脏增厚是EGV患者发生破裂出血的危险因素。
Objective To detect the risk factors for bleeding in patients with cirrhosis and esophageal and gastric varices(EGV)and better understand the potentially life-threatening complications.Methods Retrospectively,and a total of 309 patients with cirrhosis and EGV were enrolled in this study and were divided into the observation group and control based on EGV bleeding or not.Meanwhile,the patients'epidemiological,clinical,laboratory,and radiological characteristics were collected and analyzed to construct a prediction model.The bootstrap method could be used to validate predictive models and the ROC curves to evaluate its forecasting ability.Results High-density lipoprotein(HDL)(P<0.001,OR=0.131,95%CI=0.049-0.350),C-reactive protein(CRP)(P=0.010,OR=2.657,95%CI=1.269-5.563),the width of portal vein(PVW)(P=0.050,OR=1.156,95%CI=1.000-1.336),the thickness of spleen(P=0.035,OR=1.492,95%CI=1.028-2.165),Child-Pugh grade B(P=0.003,OR=11.320,95%CI=2.232-57.407)and Child-Pugh grade C(P=0.002,OR=3.888,95%CI=1.659-9.114)were significantly associated with the occurrence of EGV bleeding.The AUC of the predictive risk model in the modeling group was 0.802,and the validation group was 0.836.Conclusion The lower HDL and higher CRP,PVW,the thickness of the spleen,Child-Pugh grade B and C are the risk factors for the occurrence of EGV bleeding.
作者
白雪
刘晓艳
杜文军
张忠法
Bai Xue;Liu Xiaoyan;Du Wenjun;Zhang Zhongfa(Dept of Liver Diseases,Shandong Public Health Clinical Center Affiliated to Shandong University,Jinan 250000)
出处
《安徽医科大学学报》
CAS
北大核心
2024年第1期149-153,共5页
Acta Universitatis Medicinalis Anhui
基金
山东省重点研发计划(编号:2021SFGC0504)。
