食管胃底静脉曲张患者出血的预测因子:基于风险预测模型的系统评价与meta分析

摘要/Abstract

摘要： 目的评价食管胃底静脉曲张出血(EGVB)风险预测模型的预测因子。方法检索PubMed、EMbase、Web of Science、The Cochrane Library、SinoMed、中国知网、万方、维普、中华医学期刊全文数据库等中英文数据库中,与EGVB风险预测模型相关的研究,检索时限为建库至2025年1月6日。采用PROBAST工具进行文献偏倚风险及适用性评价。采用R程序(4.4.2版)、MedCalc软件对模型进行meta分析。结果共纳入12项研究,包括英文文献4篇和中文文献8篇。预测模型受试者工作特征曲线下面积(AUC)为0.802~0.994。通过MedCalc软件对模型AUC进行meta分析,合并后的AUC为0.888(95%CI:0.857~0.919)。结果显示,血小板(OR=0.98, 95%CI: 0.97~0.99)、脾脏厚度(OR=1.11, 95%CI:1.09~1.14)、肝脏表面粗糙(OR=6.54, 95%CI:4.65~9.24)、腹水(OR=3.83, 95%CI:1.55~9.50)和红色征(OR=4.48, 95%CI: 2.81~7.13)是EGVB风险预测模型的有效预测因子(P<0.05)。结论 EGVB风险的预测模型尚处于探索阶段,未来可开展多中心、大样本的前瞻性临床研究,完善模型构建方法,尽早开发识别准确度更高的EGVB风险预测模型。

关键词: 食管胃底静脉曲张, 出血, 风险预测模型, 系统评价, Meta分析

Abstract: Objective Systematic evaluation of predictors of esophageal and gastric variceal bleeding risk prediction models for clinical construction of relevant models and clinical practice. Methods A comprehensive search for studies related to predictive models of esophageal and gastric variceal bleeding (EGVB) risk was conducted in Chinese and English databases, including PubMed, EMbase, Web of Science, the Cochrane Library, SinoMed, China Knowledge, Wanfang, Wipro, and Chinese Medical Journal Full Text Databases, with a timeframe of the construction of the library to January 6, 2025, for the search. The information of the included literature was extracted by two researchers, and the risk of literature bias and applicability were evaluated using the PROBAST tool. The meta-analysis of the model was performed using the R program (version 4.4.2), MedCalc software. Results A total of 12 studies were included, including 4 English literature and 8 Chinese literature. The area under the curve (AUC) of the subjects in the predictive model was 0.802~0.994. Meta-analysis was conducted on the AUC of the model using MedCalc software, and the combined AUC was 0.888 (95%CI: 0.857~0.919). The results of the meta-analysis showed that platelet (OR=0.98, 95%CI: 0.97~0.99), spleen thickness (OR=1.11, 95%CI:1.09~1.14), liver rough surface (OR=6.54, 95%CI:4.65~9.24), ascites (OR=3.83, 95%CI:1.55~9.50), and red color sign (OR=4.48, 95%CI: 2.81~7.13) were effective predictors in the predictive model for the risk of esophageal and gastric variceal bleeding (P<0.05). Conclusion Predictive models for the risk of EGVB are still in the exploratory stage. In the future, prospective clinical studies with multicenter and expanded sample sizes can be carried out to improve the methodology of model construction and to develop a risk prediction model for EGVB with a higher degree of identification accuracy as early as possible.

Key words: Esophageal and gastric varices, Bleeding, Risk prediction model, Systematic evaluation, Meta-analysis

苏成得, 朱芊芊, 李明丹, 徐亚丽, 刘倩, 张滢, 张心怡, 王华君, 李秋香, 杨平. 食管胃底静脉曲张患者出血的预测因子:基于风险预测模型的系统评价与meta分析[J]. 肝脏, 2026, 31(4): 508-516.

SU Cheng-de, ZHU Qian-qian, LI Ming-dan, XU Ya-li, LIU Qian, ZHANG Ying, ZHANG Xin-yi, WANG Hua-jun, LI Qiu-xiang, YANG Ping. Predictors of bleeding in patients with esophageal and gastric varices: a systematic review and meta-analysis based on risk prediction models[J]. Chinese Hepatolgy, 2026, 31(4): 508-516.

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