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食管胃静脉曲张治疗后再出血预测模型的建立与评价
Establishment and evaluation of a predictive model for rebleeding after endoscopic treatment of esophageal and gastric varices
文章发布日期:2019年08月19日  来源:  作者:艾正琳,洪珊,胡居龙,等  点击次数:94次  下载次数:18次

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【摘要】:目的建立内镜下聚桂醇联合组织胶治疗食管胃静脉曲张患者发生再出血的预测模型,并交叉验证预测模型的准确率。方法选取2014年1月-2016年12月于北京地坛医院住院治疗的180例食管胃静脉曲张出血的患者,回顾性分析其中126例患者的临床资料,包括年龄、性别、实验室指标、Child-Pugh评分、静脉曲张程度等指标。运用logistic回归分析筛选再出血的独立预测因素,并建立预测模型,选取另54例患者的临床资料进行交叉验证该预测模型的准确率。计量资料2组间比较采用独立样本t检验;计数资料2组间比较采用χ2检验。多因素分析采用logistic回归法并建立预测模型。采用受试者工作特征曲线(ROC曲线)评价预测模型,并交叉验证模型的准确率。结果126例患者中1年内再出血发生率为46.83%,再出血组与未出血组患者比较, PLT(t=-7.488,P<0.001)、国际标准化比值(t=3.145,P=0.002)﹑食管静脉曲张的程度(χ2=8.841,P=0.031)差异均有统计学意义。多因素logistic回归分析显示性别[比值比(OR)=3.366,95%可信区间(95%CI):1.015~11.166,P=0.047]、PLT(OR=0.922,95%CI:0.893~0.951,P<0.001)、食管静脉曲张程度(OR=2.422,95%CI:1.179~4.977,P=0.016)是再出血的独立预测因素,3个危险因素联合建立预测模型的ROC曲线下面积0.876,灵敏度为86.0%,特异度为83.1%。选取另54例患者进行交叉验证,预测模型的准确率为92.6%。结论男性、重度静脉曲张是再出血的高危因素,血小板是保护性因素,三者拟合模型预测再出血率具有一定的价值,其准确率可达92.6%。
【Abstract】:ObjectiveTo establish a predictive model for rebleeding after endoscopic injection of lauromacrogol combined with tissue adhesive in patients with esophageal and gastric varices, and to investigate its accuracy by cross validation. MethodsA total of 180 patients with esophagogastric variceal bleeding who were admitted to Beijing Ditan Hospital from January 2014 to December 2016 were enrolled, and a retrospective analysis was performed for the clinical data of 126 patients, including age, sex, laboratory markers, Child-Pugh score, and degree of esophageal and gastric varices. A logistic regression analysis was used to screen out independent predictive factors for rebleeding and establish a predictive model, and the clinical data of the other 54 patients were used for cross validation of the accuracy of this model. The t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The logistic regression method was used to perform multivariate analysis and establish the predictive model. The receiver operating characteristic (ROC) curve was used for evaluation of this model and cross validation of its accuracy. ResultsThe 1-year rebleeding rate was 46.83% in 126 patients, and there were significant differences between the rebleeding group and the non-rebleeding group in platelet count (t=-7.488, P<0.001), international normalized ratio (t=3.145, P=0.002), and degree of esophageal varices (χ2=8.841, P=0.031). The multivariate logistic regression analysis showed that sex (odds ratio [OR]=3.366, 95% confidence interval [CI]: 1.015-11.166, P=0.047), platelet count (OR=0.922, 95%CI: 0.893-0.951, P<0.001), and degree of esophageal varices (OR=2.422, 95%CI: 1.179-4.977, P=0.016) were independent predictive factors for rebleeding. The predictive model based on the combination of these three factors had an area under the ROC curve of 0.876, a sensitivity of 86.0%, and a specificity of 83.1%. Cross validation based on the clinical data of the other 54 patients showed that this predictive model had an accuracy of 92.6%. Conclusion Male sex and severe varices are high-risk factors for rebleeding, and platelet count is a protective factor. The predictive model based on the combination of these three factors has a certain value in predicting rebleeding, with an accuracy of 92.6%.
【关键字】:食管和胃静脉曲张; 出血; 危险因素
【Key words】:esophageal and gastric varices; hemorrhage; risk factors
【引证本文】:AI ZL, HONG S, HU JL, et al. Establishment and evaluation of a predictive model for rebleeding after endoscopic treatment of esophageal and gastric varices[J]. J Clin Hepatol, 2019, 35(9): 1954-1957. (in Chinese)
艾正琳, 洪珊, 胡居龙, 等. 食管胃静脉曲张治疗后再出血预测模型的建立与评价[J]. 临床肝胆病杂志, 2019, 35(9): 1954-1957.

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