中国临床医学2024，Vol.31Issue(3)：353-360,8.DOI:10.12025/j.issn.1008-6358.2024.20240315
内镜干预时机对肝硬化食管胃静脉曲张出血患者近期预后的影响及死亡相关因素分析
Impact of timing of endoscopic intervention on the short-term prognosis and analysis of risk factors for mortality in patients with liver cirrhosis complicated by esophageal and gastric variceal bleeding
摘要
Abstract
Objective To investigate the effect of different timing of endoscopic intervention on the short-term prognosis of patients with cirrhosis combined with esophageal and gastric variceal bleeding(EGVB),as well as to analyze the independent related factors affecting 6-week mortality of patients with EGVB and to construct a prediction model.Methods The patients with EGVB admitted to Renmin Hospital of Wuhan University for emergency endoscopic intervention from June 2021 to December 2023 were consecutively included.According to the timing of endoscopic intervention,they were categorized into the urgent endoscopy group(within 6 hours after the consultation,n=94)and the early endoscopy group(6-24 hours after the consultation,n=76).All the enrolled patients underwent a 6-week postoperative follow-up.The propensity score matching(PSM)was used as 1∶1,and baseline characteristics before and after PSM,operation related information,short-term prognosis,etc.after PSM between the two groups were compared.The binary logistic regression was used to analyze the factors influencing the 6-week mortality of patients with EGVB.A nomogram model based on the independent related factors were constructed,and ROC,calibration,and decision curves were used to verify the prognostic value of the model.Results There were significant differences in the model of end-stage liver disease(MELD)score,total bilirubin level,propotions of patients with systolic blood pressure＜90 mmHg,diabetes mellitus or initial bleeding event between the two groups(P＜0.05).After PSM,a total of 106 patients met the criteria.There was no significant difference in baseline date,operation related information,complications after operation,and 6-week mortality rate after operation between the two groups with 53 patients in each group after PSM.Blood product consumption was significantly higher in the urgent endoscopy group than that in the early endoscopy group(P=0.046).The binary logistic regression analysis results showed that initial bleeding,higher Charson comorbidity index(CCI)score,active bleeding and longer duration of surgery were independent related factors for 6-week mortality after operation in patients with EGVB(P＜0.05),whereas timing of endoscopic intervention was not a related factor for 6-week mortality.A nomogram model was constructed and AUC of the model was 0.790,with higher accuracy and utility.Conclusions The association of endoscopic intervention timing with 6-week mortality after operation in patients with EGVB is not significant obvious;the prognostic value of the model basing on initial bleeding,CCI score,active bleeding and surgery duration is higher for 6-week mortality after operation in patients with EGVB.关键词
肝硬化/门静脉高压/食管胃静脉曲张出血/急诊内镜干预Key words
cirrhosis/portal hypertension/esophageal and gastric variceal bleeding/emergency endoscopy intervention分类
医药卫生引用本文复制引用
古盼瑶,陈明锴..内镜干预时机对肝硬化食管胃静脉曲张出血患者近期预后的影响及死亡相关因素分析[J].中国临床医学,2024,31(3):353-360,8.基金项目
湖北省重点研发计划项目(2020BCB007),武汉大学人民医院2022年度交叉创新人才项目(JCRCFZ-2022-017).Supported by Key Research and Development Plan Project of Hubei Province(2020BCB007)and 2022 Annual Cross Innovation-Disciplinary Talent Project in Renmin Hospital of Wuhan University(JCRCFZ-2022-017). （2020BCB007）
