LSPS评分评估酒精性肝硬化并发食管胃底静脉曲张出血患者短期预后的价值

肝脏 ›› 2021, Vol. 26 ›› Issue (8): 874-878.

LSPS评分评估酒精性肝硬化并发食管胃底静脉曲张出血患者短期预后的价值

周佳美, 班志超, 张晓娟, 李艳, 张咏华, 王明蕾, 王会哲, 张欣

072750 河北保定市第二中心医院消化内科(周佳美,班志超,李艳,张咏华,王明蕾,王会哲,张欣),医院感染管理科(张晓娟)

收稿日期:2020-09-23 出版日期:2021-08-31 发布日期:2021-09-29
通讯作者: 张欣,Email:zhagx205@163.com
基金资助:
保定市科技计划项目(17ZF132)

The value of LSPS score in evaluating the short-term prognosis of patients with alcoholic cirrhosis complicated with esophageal gastric variceal bleeding

ZHOU Jia-mei¹, BAN Zhi-chao¹, ZHANG Xiao-juan², LI Yan¹, ZHANG Yong-hua¹, WANG Ming-lei¹, WANG Hui-zhe¹, ZHANG Xin¹

1. Department of Gastroenterology, Second Central Hospital of Baoding, Baoding 072750, Hebei;
2. Department of infection management, Second Central Hospital of Baoding, Baoding 072750, Hebei

Received:2020-09-23 Online:2021-08-31 Published:2021-09-29
Contact: ZHANG Xin,Email:zhagx205@163.com

摘要/Abstract

摘要： 目的探究肝硬度×脾脏直径/血小板计数(LSPS)评分评估酒精性肝硬化并发食管胃底静脉曲张出血(EGVB)患者短期预后的价值。方法回顾性分析2017年5月至2018年5月在保定市第二中心医院住院诊治的90例酒精性肝硬化并EGVB患者,根据4周内患者是否再发生出血状况分为出血组25例和未出血组65例。观察对比两组患者入院时一般临床资料、血常规、肝肾功能、凝血功能指标等,测量两组肝硬度、门静脉和脾脏直径,计算LSPS评分。单因素分析上述指标在两组间的差异,并进一步对有差异指标行Logistic回归分析,找出患者发生再出血的影响因素;并用受试者操作特征(ROC)曲线评估LSPS评分对酒精性肝硬化并发EGVB患者短期内发生再出血的预测价值。结果出血组失血量、门静脉内径、脾脏直径、肝硬度值和LSPS评分均明显高于未出血组,肝功能分级C级占比较大,两组比较差异具有统计学意义(P<0.05)。Logistic回归分析表明,门静脉内径、脾脏直径增大以及肝硬度值、LSPS评分升高均是影响患者短期内再发生出血的危险因素。另ROC曲线显示,LSPS评分(AUC=0.960)对患者短期发生再出血的预测价值明显高于门静脉内径(AUC=0.822)、脾脏直径(AUC=0.866)、肝硬度值(AUC=0.860),截断值为4.447分,对应的敏感度和特异度分别为88.00 %、92.30 %。结论门静脉内径、脾脏直径、肝硬度值、LSPS评分均可影响患者短期预后,且LSPS评分对酒精性肝硬化并发EGVB患者短期内发生再出血具有更高的预测价值。

关键词: 肝硬度×脾脏直径/血小板计数评分, 酒精性肝硬化并发食管胃底静脉曲张出血, 短期预后

Abstract: Objective To explore the value of liver stiffness-spleen diameter-to-platelet ratio score (LSPS) in evaluating the short-term prognosis of patients with alcoholic cirrhosis complicated with esophageal gastric variceal bleeding (EGVB).Methods A total of 90 patients with alcoholic cirrhosis and EGVB who were hospitalized in Second Central Hospital of Baoding from May 2017 to May 2018 were retrospectively analyzed. According to whether the patients suffered from rebleeding within 4 weeks, they were divided into bleeding group (25 cases) and non-bleeding group (65 cases). The general clinical data, blood routine, liver and kidney functions, coagulation function indexes were observed and compared. The liver hardness, portal vein and spleen diameter of the two groups were measured and LSPS were calculated. The difference between these two groups was analyzed by single factor analysis, followed by Logistic regression analysis to identify the risk factors of rebleeding. In addition, the predictive value of LSPS score for short-term rebleeding in patients with alcoholic cirrhosis complicated with EGVB was evaluated by receiver operating characteristic curve (ROC).Results The bleeding volume, the diameter of portal vein, the diameter of spleen, the hardness of liver, the proportion of liver function Child-Pugh grade C, and LSPS in the bleeding group were significantly higher than those in the non-bleeding group (P<0.05). Logistic regression analysis showed that the increases of the diameter of portal vein, the diameter of spleen, the hardness of liver and LSPS were the risk factors for the recurrence of bleeding in a short period of time. In addition, ROC curve showed that the predictive value of LSPS (AUC=0.960) for short-term rebleeding was significantly higher than those of portal vein diameter (AUC=0.822), spleen diameter (AUC=0.866) and liver hardness value (AUC=0.860), the cutoff value was 4.447, and the corresponding sensitivity and specificity were 88.00% and 92.30%, respectively.Conclusion The diameter of portal vein, the diameter of spleen, the hardness of liver and LSPS can affect the short-term prognosis of patients, and LSPS has a higher predictive value for the short-term rebleeding in patients with alcoholic cirrhosis and EGVB.

Key words: Liver stiffness-spleen diameter-to-platelet ratio score, Alcoholic cirrhosis complicated with esophageal gastric variceal bleeding, Short-term prognosis

周佳美, 班志超, 张晓娟, 李艳, 张咏华, 王明蕾, 王会哲, 张欣. LSPS评分评估酒精性肝硬化并发食管胃底静脉曲张出血患者短期预后的价值[J]. 肝脏, 2021, 26(8): 874-878.

ZHOU Jia-mei, BAN Zhi-chao, ZHANG Xiao-juan, LI Yan, ZHANG Yong-hua, WANG Ming-lei, WANG Hui-zhe, ZHANG Xin. The value of LSPS score in evaluating the short-term prognosis of patients with alcoholic cirrhosis complicated with esophageal gastric variceal bleeding[J]. Chinese Hepatolgy, 2021, 26(8): 874-878.

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