肝硬化门静脉高压症并发食管胃底静脉曲张破裂出血介入术后死亡风险预测模型

肝脏 ›› 2025, Vol. 30 ›› Issue (2): 183-186.

肝硬化门静脉高压症并发食管胃底静脉曲张破裂出血介入术后死亡风险预测模型

马志刚, 刘丽丽, 王旭, 冯鹏丽, 杨帆, 杨永宾

072750 河北保定市第二中心医院导管介入室(马志刚),消化内科(王旭),CT室(冯鹏丽),药剂科(杨帆);定州市人民医院健康体检科(刘丽丽);河北省人民医院心血管外科(杨永宾)

收稿日期:2023-12-31 出版日期:2025-02-28 发布日期:2025-03-17
基金资助:
2022年度河北省医学适用技术跟踪项目(GZ2022005);2023年保定市科技计划自筹经费项目(第一批)(2341ZF039)

A prediction model of mortality risk after interventional operation on cirrhotic portal hypertensive patients complicated with esophagogastric varices rupture and hemorrhage

MA Zhi-gang¹, LIU Li-li², WANG Xu³, FENG Peng-li⁴, YANG Fan⁵, YANG Yong-bin⁶

1. Catheter Intervention Room , Baoding Second Central Hospital, Hebei 072750,China;
2. Department of Health Examination, People's Hospital of Dingzhou City, Hebei 073000, China;
3. Department of Gastroenterology, Baoding Second Central Hospital, Hebei 072750,China;
4. CT Room, Baoding Second Central Hospital, Hebei 072750,China;
5. Department of Pharmacy, Baoding Second Central Hospital, Hebei 072750,China;
5. Baoding Second Central Hospital, Hebei 072750,China;
6. Department of Cardiovascular Surgery, Hebei People's Hospital , Shijiazhuang 050051, China

Received:2023-12-31 Online:2025-02-28 Published:2025-03-17

摘要/Abstract

摘要： 目的探讨肝硬化门静脉高压症(portal hypertention,PHT)并发食管胃底静脉曲张破裂出血(esophageal and gastric varices bleeding,EGBV)介入术后死亡风险预测模型的价值。方法选取2020年1月至2021年12月保定市第二中心医院收治的112例PHT并发EGBV患者,均采取经颈静脉肝内门体静脉分流术进行介入治疗。随访术后1年预后生存情况。应用Cox回归分析术后死亡的影响因素,并构建预测模型。结果经颈静脉肝内门体静脉分流术介入治疗后1年生存88例(78.57%)。死亡组患者Child-Pugh分级B、C级占91.67%(22/24)、门静脉内径(15.37±5.48)mm、肝性脑病占66.67%(16/24)、失血性休克占45.83%(11/24)、甲胎蛋白(6.14±1.23)μg/L、MELD评分(16.74±2.13)分,高于存活组的68.118%(60/88)、(12.43±2.16)mm、23.86%(21/88)、18.18%(16/88)、(4.22±1.35)μg/L、(13.38±2.49)分,而血肌酐(1.42±0.39)μmol/L、白蛋白(31.46±4.38)g/L低于存活组的(1.76±0.58)μmol/L、(35.32±5.27)g/L(P<0.05)。多因素Cox回归分析结果显示,门静脉内径≥14.26 mm(HR=2.237,95%CI:1.381～3.622)、合并肝性脑病(HR=1.671,95%CI:1.671～5.745)、失血性休克(HR=2.784,95%CI:1.746～4.439)、MELD评分≥15分(HR=2.552,95%CI:1.906～3.418)是影响PHT并发EGBV术后死亡的独立危险因素(P<0.05)。预测模型预测PHT并发EGBV术后死亡的曲线下面积为0.86(95%CI:0.734~0.923),敏感度和特异度分别为83.25%和68.76%。结论门静脉内径≥14.26 mm、合并肝性脑病、失血性休克、MELD评分≥15分是PHT并发EGBV介入术后死亡的独立危险因素,根据危险因素构建的预测模型对术后死亡具有较好预测价值。

关键词: 肝硬化门静脉高压症, 食管胃底静脉曲张破裂出血, 术后死亡, 预测模型

Abstract: Objective To explore a model for predicting the risk of death following intervention therapy in cirrhotic portal hypertensive (PHT) patients complicated with esophageal and gastric varices bleeding (EGBV). Methods One hundred and twelve patients with PHT complicated with EGBV admitted to our hospital from January 2020 to December 2021 were selected. All patients were treated with intrahepatic portal vein shunt via jugular vein for intervention therapy. After 1 year's follow-up, the patients were divided into a survival group (N=88 cases) and a death group (N=24 cases). The influencing factors of postoperative death were analyzed by univariate and multivariate COX regression method, and a prediction model for the risk of death was built. Results One year after interventional jugular intrahepatic portal vein shunt operation, 88 cases (78.57%) survived. In the death group, the average of portal vein diameter was (15.37±5.48) mm; the ratio of cases with Child Pugh grade B and C was 91.67% (22/24), with hepatic encephalopathy was 66.67% (16/24). The ratio of hemorrhagic shock was 45.83% (11/24), the level of alpha-fetoprotein was (6.14±1.23)μg/L, and the average of MELD score was (16.74±2.13), which were higher than those of 68.118% (60/88), (4.22±1.35) μg/L, and (13.38±2.49) in the survival group. The levels of Serum creatinine (1.42±0.39) μmol/L and albumin (31.46±4.38)g/L in the death group were lower than those of (1.76±0.58)μmol/L and (35.32±5.27)g/L in the survival group (P<0.05). Multivariate COX regression analysis showed that portal vein diameter≥14.26mm {(Hazard Ratio (HR)=2.237, 95%CI=1.381~3.622), combined with hepatic encephalopathy (HR=1.671, 95%CI=1.671~5.745), hemorrhagic shock (HR=2.784, 95%CI=1.746~4.439) and MELD score≥15 points (HR=2.552, 95%CI=1.906~3.418) were independent risk factors for postoperative death in cirrhotic patients with intervention therapy for PHT complicated with EGBV (HR>1, P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve of the predictive model for postoperative death was 0.86 (95%CI=0.734~0.923), and the sensitivity and specificity were 83.25% and 68.76%, respectively. Conclusion Portal vein diameter ≥14.26mm, hepatic encephalopathy, hemorrhagic shock, MELD score ≥15 points were independent risk factors for postoperative death in cirrhotic patients after intervention therapy for PHT complicated with EGBV, and the prediction model for postoperative death built on these risk factors had good predictive value.

Key words: Cirrhotic portal hypertension, Esophageal and gastric varices rupture and hemorrhage, Postoperative death, Prediction model

马志刚, 刘丽丽, 王旭, 冯鹏丽, 杨帆, 杨永宾. 肝硬化门静脉高压症并发食管胃底静脉曲张破裂出血介入术后死亡风险预测模型[J]. 肝脏, 2025, 30(2): 183-186.

MA Zhi-gang, LIU Li-li, WANG Xu, FENG Peng-li, YANG Fan, YANG Yong-bin. A prediction model of mortality risk after interventional operation on cirrhotic portal hypertensive patients complicated with esophagogastric varices rupture and hemorrhage[J]. Chinese Hepatolgy, 2025, 30(2): 183-186.

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