食管静脉曲张破裂出血内镜下套扎术患者凝血功能与营养指数对预后的预测价值分析

doi:10.3969/j.issn.1006-6233.2023.03.024

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摘要 目的: 探讨食管静脉曲张破裂出血内镜下套扎术(EVL)患者凝血功能与营养指数对预后的预测价值。方法: 将2019年12月至2021年12月期间于我科行EVL术的152例食管静脉曲张破裂出血患者根据预后分为再出血组与无再出血组,比较两组患者的临床资料,采用多因素Logistic回归分析探讨患者术后早期再出血的独立预测因素,并采用受试者工作曲线(ROC)的曲线下面积(AUC)来评估各指标对术后早期再出血的预测价值。结果: 全部患者均成功完成EVL术,短期止血成功率达100%,随访表明有15例(9.9%)患者在EVL术后6周内再次出血,发生在术后15.3d(4~36d)。再出血组患者的Child-Pugh分级为C级、门静脉血栓、重度食管静脉曲张的发生率、EVL术的总套扎环数、凝血酶原时间(PT)、活化的部分凝血活酶时间、总胆红素等显著高于无再出血组,血红蛋白、血小板、白蛋白、预后营养指数(PNI)评分显著低于无再出血组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果表明门静脉血栓、PT、PNI评分是患者EVL术后早期再出血的独立预测因素(P<0.05)。ROC曲线表明全部患者术前PT与PNI评分对术后早期再出血的预测价值较高,AUC(95%CI)分别为0.751(0.569~0.932)、0.731(0.466~0.974)。结论: 食管静脉曲张破裂出血患者EVL术前PT与PNI评分是术后早期再出血发生的独立预测因素,对手术预后具有较高的预测价值。

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关键词 ：内镜下静脉曲张套扎术, 食管静脉曲张破裂出血, 凝血酶原时间, 预后营养指数, 预后, 预测

Abstract：Objective: To analyze the predictive value of coagulation function and nutritional index on prognosis in patients with esophageal varices bleeding undergoing endoscopic variceal ligation(EVL). Methods: One hundred and fifty-two patients with esophageal variceal bleeding who underwent EVL in our department from December 2019 to December 2021 were divided into rebleeding group and non-rebleeding group according to the prognosis. The clinical data were compared between the two groups, and multivariate Logistic regression analysis was used to explore the independent predictors of early rebleeding. The area under the curve(AUC)of receiver operating curve(ROC) was performed to evaluate the predictive value of index for early postoperative rebleeding. Results: All patients successfully completed EVL, and the success rate of short-term hemostasis was 100%. The follow-up result showed that 15 patients(9.9%) had rebleed within 6 weeks after EVL, which occurred 15.3 days(4~36 days) after EVL. The incidences of Child-Pugh grade C, portal vein thrombosis, severe esophageal varices, the total number of ligation rings, prothrombin time(PT), activated partial thromboplastin time and total bilirubin level in rebleeding group were significantly higher than those in non-rebleeding group, and the levels of hemoglobin, platelet, albumin and prognostic nutritional index(PNI)score were significantly lower than that of non-rebleeding group(P<0.05). Multivariate logistic regression analysis showed that portal vein thrombosis, PT and PNI score were the independent predictors of early rebleeding after EVL (P<0.05). The result of ROC curve showed that the preoperative PT and PNI score of all patients had a high predictive value for early postoperative rebleeding, and their AUC (95% CI) were 0.751 (0.569 ～ 0.932) and 0.731 (0.466 ～ 0.974) respectively. Conclusion: PT and PNI score of patients with esophageal variceal bleeding before EVL were the independent predictors of postoperative early rebleeding, and they had a high predictive value for surgical prognosis.

Key words： Endoscopic variceal ligation Esophageal varices bleeding Prothrombin time Prognostic nutritional index Prognosis Forecast

基金资助:军队细菌性传染病病原谱流行规则及变异研究,(编号:2018ZX10713003-001)

引用本文:

袁成雪, 许婷, 张宗霞. 食管静脉曲张破裂出血内镜下套扎术患者凝血功能与营养指数对预后的预测价值分析[J]. 河北医学, 2023, 29(3): 472-476.
YUAN Chengxue, et al. Predictive Value of Coagulation Function and Nutritional Index on Prognosis in Patients with Esophageal Varices Bleeding Undergoing Endoscopic Variceal Ligation. HeBei Med, 2023, 29(3): 472-476.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2023.03.024 或 http://www.hbyxzzs.cn/CN/Y2023/V29/I3/472