乙型肝炎肝硬化患者食管胃底静脉破裂出血后获得再代偿的影响因素分析

摘要/Abstract

摘要： 目的研究以食管胃底静脉曲张破裂出血(EGVB)为首发失代偿表现的乙型肝炎肝硬化患者实现再代偿的影响因素。方法收集2018年1月1日至2023年12月31日就诊于徐州医科大学附属医院的首发失代偿表现为EGVB的乙型肝炎肝硬化患者107例,按照《慢性乙型肝炎防治指南(2022版)》标准对乙型肝炎肝硬化再代偿的定义与随访结果,将患者分为再代偿组(n=44)和持续失代偿组(n=63),收集患者的临床资料,包括人口学特征、实验室检查结果、影像学资料及治疗情况。比较采用Mann-Whitney U检验、χ²检验或Fisher′s 确切概率法。运用二元logistic回归分析影响实现再代偿的独立因素,运用受试者工作特征曲线下面积(AUC)评估预测效能。结果 107例EGVB患者中,44例患者出现再代偿(41.1%),再代偿组年龄、血钾、血氯、合并糖尿病分别为(46.1±9.2)岁、3.93 mmol/L、104.85 mmol/L、4.55%,均低于持续失代偿组的(52.3±11.9)岁、4.03 mmol/L、105.90 mmol/L、19.05%,再代偿组行脾切除联合贲门周围血管离断术(SPD)水平高于持续失代偿组,为40.91%比9.52%,差异有统计学意义(t/χ²=2.91,-2.04,-1.97,4.79,14.67,均P<0.05)。Logistic回归分析显示,年龄增加、总胆红素水平升高、SPD治疗是实现再代偿的独立影响因素(95%CI: 0.90 ~ 0.99、0.90 ~ 0.99、1.95 ~ 16.52,OR=0.94、0.94、5.68,均P<0.05)。ROC分析显示,年龄、SPD治疗史、总胆红素的AUC分别为0.64,0.65,0.56,灵敏度分别为0.46、0.90、0.68,特异度分别为0.30、0.41、0.05,联合预测模型的AUC为0.79,灵敏度为0.73,特异度为0.70。结论年龄增加及总胆红素升高的乙型肝炎肝硬化EGVB患者不易实现再代偿,而行SPD的患者易获得再代偿。

关键词: 乙型肝炎, 肝硬化, 食管胃底静脉曲张破裂出血, 危险因素

Abstract: Objective To identify the factors influencing recompensation in patients with hepatitis B virus (HBV)-related cirrhosis presenting with esophageal-gastric variceal bleeding (EGVB) as their first de-compensation event. Methods A total of 107 HBV-related cirrhotic patients with EGVB as initial de-compensation event who were treated in the Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2023 were enrolled in this study. The patients were categorized into a re-compensation group (n=44) and a persistent de-compensation group (n=63) according to the criteria for re-compensation from Chinese Society of Hepatology at 2022. Demographic, laboratory, imaging, and treatment data were collected from all patients. Intergroup comparisons were performed using Mann-Whitney U test、χ² or Fisher′s exact test. The independent factors influencing recompensation were identified by binary logistic regression analysis, and the performance of predictive value was evaluated using the area under the receiver operating characteristic curve (AUC) method. Results Among 107 patients with esophageal-gastric variceal bleeding, re-compensation was observed in 44 cases (41.1%). In the re-compensation group, age, serum potassium, serum chloride, and the proportion of diabetes mellitus were recorded as (46.1±9.2) years, 3.93 mmol/L, 104.85 mmol/L, and 4.55%, respectively, which were all lower than those of [(52.3±11.9) years, 4.03 mmol/L, 105.90 mmol/L, and 19.05%] in the persistent de-compensation group. A higher rate of splenectomy combined with pericardial de-vascularization (SPD) was found in the re-compensation group compared to the persistent de-compensation group (40.91% vs. 9.52%), with statistically significant differences (t/χ²=2.91, -2.04, -1.97, 4.79, 14.67, all P<0.05). By Logistic regression analysis it was revealed that increased age, elevated total bilirubin levels, and SPD treatment were identified as independent influencing factors for recompensation (95% CI: 0.90~0.99, 0.90~0.99, 1.95~16.52; OR=0.94, 0.94, 5.68, all P<0.05). ROC analysis showed that the AUC values for age, SPD treatment history, and total bilirubin were 0.64, 0.65, and 0.56, respectively, with sensitivities of 0.46, 0.90, and 0.68, and specificities of 0.30, 0.41, and 0.05. The combined predictive model achieved an AUC of 0.79, with a sensitivity of 0.73 and a specificity of 0.70. Conclusion HBV-related cirrhotic patients with EGVB who are older or have elevated total bilirubin are less likely to achieve re-compensation, while those undergoing SPD are more likely to attain re-compensation.

Key words: Hepatitis B virus, Liver cirrhosis, Esophagogastric variceal bleeding, Risk factors

吕敏, 刘雯, 谷梦迪, 姚智博, 丁芹. 乙型肝炎肝硬化患者食管胃底静脉破裂出血后获得再代偿的影响因素分析[J]. 肝脏, 2026, 31(8): 1091-1095.

Lv Min, Liu Wen, Gu Mengdi, Yao Zhibo, Ding Qin. An analysis on the predictors of recompensation in hepatitis B virus-related cirrhotic patients following esophagogastric variceal bleeding[J]. Chinese Hepatolgy, 2026, 31(8): 1091-1095.

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