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基于倾向性评分匹配分析门静脉血栓对肝硬化患者预后的影响

肖春桃 李贤秋 甘佩灵 潘潇 周贤

肖春桃,李贤秋,甘佩灵,等. 基于倾向性评分匹配分析门静脉血栓对肝硬化患者预后的影响[J]. 临床肝胆病杂志, 2021, 37(8): 1829-1835. DOI: 10.3969/j.issn.1001-5256.2021.08.017
引用本文: 肖春桃,李贤秋,甘佩灵,等. 基于倾向性评分匹配分析门静脉血栓对肝硬化患者预后的影响[J]. 临床肝胆病杂志, 2021, 37(8): 1829-1835. DOI: 10.3969/j.issn.1001-5256.2021.08.017
XIAO CT, LI XQ, GAN PL, et al. Influence of portal vein thrombosis on the prognosis of patients with liver cirrhosis based on propensity score matching[J]. J Clin Hepatol, 2021, 37(8): 1829-1835. DOI: 10.3969/j.issn.1001-5256.2021.08.017
Citation: XIAO CT, LI XQ, GAN PL, et al. Influence of portal vein thrombosis on the prognosis of patients with liver cirrhosis based on propensity score matching[J]. J Clin Hepatol, 2021, 37(8): 1829-1835. DOI: 10.3969/j.issn.1001-5256.2021.08.017

基于倾向性评分匹配分析门静脉血栓对肝硬化患者预后的影响

DOI: 10.3969/j.issn.1001-5256.2021.08.017
详细信息
    通讯作者:

    周贤,853023378@qq.com

  • 中图分类号: R575.2

Influence of portal vein thrombosis on the prognosis of patients with liver cirrhosis based on propensity score matching

  • 摘要:   目的  分析门静脉血栓(PVT)对肝硬化患者短期预后的影响并探讨肝硬化患者预后的危险因素。  方法  回顾性分析西南医科大学附属医院2018年9月—2020年3月的肝硬化住院患者临床资料,其中合并PVT患者58例为PVT组,随机选取同期无PVT患者116例为非PVT组,通过1∶ 1倾向性评分匹配(PSM)均衡组间协变量获取PVT组及非PVT组各44例。满足正态性计量资料2组间比较采用t检验,非正态性计量资料2组间比较采用Mann-Whitney U秩和检验;计数资料2组间比较采用χ2检验和Fisher确切概率法。利用Kaplan-Meier法及log-rank法分析PSM前后2组患者的生存情况及出血情况,并使用Cox风险模型分析PSM前后影响肝硬化患者预后的危险因素。  结果  PSM前非PVT组患者总体生存率明显高于PVT组(P=0.008),而PSM后2组患者总体生存率无明显差异(P=0.076)。PSM前非PVT组上消化道出血或再出血率明显低于PVT组(P<0.001),PSM后结果与PSM前一致(P=0.028)。PSM前肝硬化患者预后多因素分析显示,PVT(HR=2.944, 95%CI:1.364~6.441,P=0.007)和MELD评分≥15(HR=3.531,95%CI:1.630~7.650,P=0.001)是肝硬化患者短期死亡的危险因素。PSM后肝硬化患者预后多因素分析显示,MELD评分≥15是肝硬化患者短期死亡的危险因素(HR=3.312, 95%CI:1.049~10.457,P=0.041)。  结论  肝硬化合并PVT增加上消化道出血或再出血风险,但其不是肝硬化患者短期死亡的独立危险因素,MELD评分≥15是肝硬化患者短期死亡的独立危险因素。

     

  • 图  1  PVT组与非PVT组患者的总体生存曲线

    注:a, PSM前;b,PSM后。

    图  2  PVT与非PVT患者上消化道出血或再出血发生率比较

    注:a, PSM前;b,PSM后。

    图  3  MELD评分<15与MELD评分≥15患者的总体生存率比较

    注:a, PSM前;b,PSM后。

    表  1  PSM前后2组患者基线特征比较

    变量 匹配前 匹配后
    PVT组(n=58) 非PVT组( n=116) 统计值 P PVT组(n=44) 非PVT组(n=44) 统计值 P
    性别[例(%)] χ2=0.207 0.649 χ2=0.218 0.640
      男 40(68.97) 76(65.52) 32(72.73) 30(68.18)
      女 18(31.03) 40(34.48) 12(27.27) 14(31.82)
    年龄(岁) 57.10±11.81 56.09±10.45 t=-0.574 0.566 56.14±12.27 56.89±10.81 t=-0.304 0.762
    病因[例(%)] χ2=1.035 0.793 χ2=0.255 0.968
      病毒1) 37(63.80) 71(61.21) 29(65.91) 29(65.91)
      酒精 11(19.00) 18(15.52) 7(15.91) 7(15.91)
      混合2) 3(5.17) 9(7.76) 3(6.82) 4(9.09)
      其他 7(12.07) 18(15.52) 5(11.36) 4(9.09)
    病程3)[例(%)] χ2=16.289 0.001 χ2=4.356 0.225
      ≤1年 15(25.86) 54(46.55) 13(29.55) 11(25.00)
      1~≤5年 19(32.76) 37(31.90) 15(34.09) 18(40.91)
      5~≤10年 7(12.07) 16(13.80) 5(11.36) 10(22.73)
      >10年 17(29.31) 9(7.76) 11(25.00) 5(11.36)
    吸烟史[例(%)] χ2=0.307 0.580 χ2=0.809 0.368
      有 20(34.48) 45(38.79) 17(38.64) 13(29.55)
      无 38(65.52) 71(61.21) 27(61.36) 31(70.45)
    糖尿病[例(%)] χ2=0.021 0.886 χ2=0.723 0.395
      有 10(17.24) 19(16.38) 6(13.64) 9(20.45)
      无 48(82.76) 97(83.62) 38(86.36) 35(79.55)
    高血压[例(%)] χ2=0.244 0.622 χ2=0.000 1.000
      有 8(13.79) 13(11.21) 6(13.64) 6(13.64)
      无 50(86.21) 103(88.79) 38(86.36) 38(86.36)
    Child-Pugh评分 8.00(7.00~9.00) 8.00(7.00~10.00) Z=-0.183 0.855 8.07±1.97 8.23±2.13 t=-0.363 0.717
    MELD评分 10.78±4.78 11.97±5.39 t=1.435 0.153 10.73±4.16 11.30±4.71 t=-0.600 0.550
    WBC(×109/L) 4.97(3.50~8.11) 4.76(3.33~6.81) Z=-0.945 0.345 4.82(3.54~7.39) 5.02(3.31~7.91) Z=-0.017 0.987
    NEU-R(%) 74.90(65.03~82.55) 69.05(60.40~78.73) Z=-2.254 0.024 72.95(64.73~81.58) 71.00(63.28~82.75) Z=-0.225 0.882
    Hb(g/L) 83.09±28.94 98.85±28.09 t=3.453 0.001 84.32±29.94 88.14±27.87 t=-0.619 0.537
    PLT(×109/L) 68.00(46.00~107.50) 70.00(49.25~96.75) Z=-0.375 0.708 68.00(46.25~113.50) 64.50(48.50~88.75) Z=-0.864 0.388
    Alb(g/L) 32.44±4.75 33.00±6.16 t=0.667 0.506 32.38±4.64 31.80±6.16 t=0.051 0.618
    ALT(U/L) 21.95(17.33~34.18) 34.07(19.15~55.13) Z=-3.141 0.002 23.25(17.90~37.25) 21.50(14.98~45.33) Z=-0.421 0.673
    AST(U/L) 34.05(25.71~54.68) 53.75(28.63~86.43) Z=-3.089 0.002 36.15(27.23~55.53) 38.15(22.40~67.88) Z=-0.013 0.990
    TBil(μmol/L) 20.95(16.27~41.08) 29.25(17.75~57.83) Z=-2.696 0.007 21.73(17.05~44.73) 24.60(17.16~35.63) Z=-0.396 0.692
    GGT(U/L) 35.60(19.65~79.63) 49.10(23.43~99.93) Z=-1.911 0.056 38.10(18.68~44.73) 35.10(18.58~68.76) Z=-0.108 0.914
    ALP(U/L) 85.70(62.70~126.00) 103.25(72.00~160.03) Z=-2.233 0.025 86.75(63.38~135.20) 80.80(61.55~103.03) Z=-0.847 0.397
    SCr(μmol/L) 69.05±22.99 65.52±21.68 t=-0.992 0.323 68.94±22.61 65.83±25.68 t=0.600 0.550
    Na(mmol/L) 138.77±4.96 138.74±5.67 t=-0.033 0.973 138.69±5.10 138.91±4.10 t=-0.221 0.826
    BUN(μmol/L) 7.00(4.71~11.04) 6.16(4.52~7.81) Z=-1.960 0.050 6.50(4.68~10.69) 6.60(4.52~9.27) Z=-0.513 0.608
    PT(s) 17.69±3.18 17.30±3.26 t=-0.760 0.448 17.46±3.17 17.94±3.35 t=-0.683 0.496
    APTT(s) 39.20±6.84 40.18±6.36 t=0.940 0.349 39.12±6.54 39.49±6.53 t=-0.269 0.788
    INR 1.35(1.26~1.57) 1.35(1.19~1.54) Z=-1.127 0.260 1.34(1.24~1.54) 1.37(1.28~1.62) Z=-0.847 0.397
    PTA(%) 61.16±14.48 64.76±17.47 t=1.353 0.178 62.84±14.49 59.95±14.38 t=0.939 0.350
    D-二聚体 2.36(1.07~5.01) 1.01(0.58~2.58) Z=-3.853 <0.001 2.09(0.95~4.55) 1.74(0.48~3.84) Z=-1.006 0.315
    FIB(g/L) 2.04±0.78 2.14±1.03 t=0.691 0.491 2.07±0.68 1.89±0.81 t=1.088 0.280
    AT-Ⅲ 57.17±17.59 58.31±21.10 t=0.355 0.723 57.59±17.58 55.30±18.42 t=0.596 0.553
    脾/胃-肾分流[例(%)] χ2=6.092 0.014 χ2=0.090 0.764
      有 12(20.69) 9(7.76) 7(15.91) 6(13.64)
      无 46(79.31) 107(92.24) 37(84.09) 38(86.36)
    门静脉内径(cm) 1.57(1.40~1.79) 1.40(1.30~1.50) Z=-3.575 <0.001 1.54±0.27 1.49±0.26 t=0.892 0.375
    脾切除/栓塞史[例(%)] χ2=0.509 0.363 χ2=0.621 0.431
      有 6(10.34) 7(6.03) 5(11.36) 2(4.55)
      无 52(89.66) 109(93.97) 39(88.64) 42(95.45)
    硬化剂注射史[例(%)] χ2=0.028 0.867 χ2=0.000 1.000
      有 7(12.07) 12(10.34) 7(15.91) 7(15.91)
      无 51(87.93) 104(89.66) 37(84.09) 37(84.09)
    注:1)包括乙型及丙型病毒性肝炎;2)病毒性肝炎合并酒精性肝硬化;3)确诊肝硬化到此次住院的间隔时间。
    下载: 导出CSV

    表  2  PSM前后肝硬化患者预后的单因素Cox分析

    变量 PSM前(n=170) PSM后(n=85)
    例数 HR 95%CI P 例数 HR 95%CI P
    性别(男/女) 113/57 0.921 0.417~2.036 0.839 59/26 0.686 0.217~2.169 0.521
    年龄(<65岁/≥65岁) 121/49 2.276 1.050~4.930 0.037 59/26 2.602 0.835~8.110 0.099
    糖尿病(是/否) 26/144 1.042 0.359~3.028 0.939 14/71 1.298 0.283~5.966 0.737
    病因
      病毒 105 0.128 56 0.790
      酒精 29 0.583 0.205~1.655 0.310 14 1.207 0.148~9.821 0.860
      混合 11 1.699 0.554~5.208 0.354 6 2.187 0.227~21.060 0.498
      其他 25 0.607 0.071~5.206 0.649 9 2.185 0.136~35.093 0.581
    病程
      ≤1年 69 0.612 24 0.669
      1~≤5年 55 0.795 0.230~2.163 0.541 32 2.099 0.218~20.235 0.521
      5~≤10年 22 0.825 0.269~2.253 0.736 15 2.307 0.269~19.812 0.446
      >10年 24 1.482 0.426~5.157 0.537 14 3.953 0.408~38.283 0.236
    Child分级(A~B级/C级) 129/41 3.093 1.430~6.689 0.004 66/19 2.899 0.919~9.151 0.069
    MELD评分(<15/≥15) 131/39 3.305 1.528~7.148 0.002 68/17 3.312 1.049~10.457 0.041
    PVT(有/无) 54/116 2.746 1.258~5.995 0.011 41/44 3.084 0.832~11.435 0.092
    PLT (<110×109/L/≥110×109/L) 135/35 1.510 0.520~4.386 0.449 68/17 1.336 0.361~4.941 0.664
    分流(是/否) 20/150 1.458 0.548~3.878 0.450 13/72 1.134 0.248~5.192 0.871
    出血1)(是/否) 83/87 2.349 1.020~5.408 0.045 55/30 2.530 0.552~11.601 0.232
    内镜手术2)(是/否) 44/126 1.587 0.598~4.215 0.354 29/56 1.108 0.332~3.690 0.868
    TIPS手术3)(是/否) 19/151 1.150 0.344~3.947 0.820 16/69 3.581 0.459~27.920 0.229
    注:1)是否出血指纳入研究时是否出血;2)是否内镜手术指纳入研究至随访结束是否行内镜手术;3)是否TIPS指纳入研究至随访结束期间是否行TIPS手术。
    下载: 导出CSV
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  • 收稿日期:  2020-12-18
  • 修回日期:  2021-01-19
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