基于APRI和PALBI构建的列线图对肝硬化并发食管胃底静脉曲张破裂出血的预测价值.docx
肝纤维化及肝硬化DOI:10.12449/JCH240314基于APRI和PALBI构建的列线图对肝硬化并发食管胃底静脉曲张破裂出血的预测价值李欣忆，李娇娇，李莹莹，魏虹合，熊雨凡，张新驰，孙蔚，陈丽苏州大学附属第一医院感染科，江苏苏州215000遹言储：蛹,756355153(ORQD:0000-0l-6278-5438)摘要：目的评估天冬氨酸转氨酶与血小板比值指数(APRI)和血小板-白蛋白-胆红素评分(PALBI)对肝硬化并发食管胃底静脉曲张破裂出血风险的预测价值方法选取苏州大学附属第一医院于2021年5月一2022年6月收治的肝硬化患者119例，收集患者的临床资料、血常规、血清生化及血凝等检直结果。根据是否合并食管胃底静脉曲张破裂出血，将患者分为未出血组(”59)和出血组(。=601,比较组间差异正态分布的计量资料两组间比较采用独立样本f检验，非正态分布的计量资料两组间比较采用Mann-WhitneyU检验。计数资料组间比较采用好检验或FiSher精确概率法。使用多因素LogiStiC回归分析，筛选肝硬化并发食管胃底静脉曲张破裂出血的独立危险因素，并构建列线图预测模型。结果出血组男性患者占75.00%,未出血组男性患者占40.68%,两组在性构成方面，差异具有统计学意义(/=14.384,P0.OOl)出血辐味出血组患者病因均以慢性乙型肝炎为主(53.33%vs38.98%),两者构成比差异无统计学意义(=2.464,P=O.116)出血组患者抗凝血酶原11I活性(AT-11IA)水平高于未出血组(t=3.329,P=O.001),PLT、TBikCa.TC,水平贝M氐于未出血组(P值均0.05).APRI和PALB库出血组和未出血组之间俄，差异均有统计学意义伍值分别为6.175、19.532,产值均005).击*，LogiStie回归分析频，APRI(OR=O.309,95%CI:0.109-0.881,P=O.028).PALBI(Off=7.667,95%C:2.00529.327,P=O.003),Ca(CR=O.001,95%C:O.(XX)0.141,P=0.CG7),TC(OFM).469,95%C:Q226O973,P=0Q2)和Tr(OH=O.599,95%C:0.433-0.830,P=O.002)期响嗨化并发食管胃曲张曝出血的3蚯题向因素。基于以因素建立列线图模型，一致怛旨数(Gindex)为0.899,校准曲线拟合良好。结论APRI及PALBl对肝硬化并发食管胃底静脉曲张破裂出血具有良好的预测价值，基于本研究构建的列线图模型可以个体化预测肝硬化患者食管胃底静脉曲张破裂出血发生率.关键词：月干硬化；食管和胃静脉曲张；胃肠出血；APRl;PALBI;列线图基金项目：“十三五"国家科技重大专项(2017ZX10203201002-002);苏州市卫生青年骨干人才"全国导师制"培训项目(201900139909)沃三三m三金(TQGB20210134)Establishmentofanomogrammodelforpredictinglivercirrhosiswithesophagogastricvaricealbleedingbasedonaspartateaminotransferase-to-plateletratioindexandplatelet-albumin-bilirubinscore1.IXinyi,LIJiaojiao,LIYingying,WEIHonghe.XIONGYufan.ZHANGXinchi,SUNWei,CHENLi.(DepartmentOflnfectiousDiseases,TheFirstAffiliatedHospitalofSoochowUniversity,Suzhou,Jiangsu2150001China)Correspondingauthor:CHENU,756355153(ORCID:0000-0001-6278-5438)Abstract:ObjectiveToinvestigatethevalueofaspartateaminotransferase-to-plateletratioindex(APRI)andplatelet-albumin-bilirubin(PALBI)scoreinpredictingtheriskofesophagogastricvaricealbleedinginpatientswithlivercirrhosis.MethodsAtotalof119patientswithlivercirrhosiswhowereadmittedtoTheFirStAffiliatedHospitalofSoochowUniversityfromMay2021andJune2022wereenrolled,andclinicaldata,routinebloodtestresults,serumbiochemistry,andcoagulationtestresultswerecollectedfromallpatients.Accordingtothepresenceorabsenceofesophagogastricvaricealbleeding,thepatientsweredividedintonon-bleedinggroupwith59patientsandbleedinggroupwith60patients,andacomparativeanalysiswasperformedforthetwogroupsTheindependentsamplesftestwasusedforcomparisonofnormallydistributedcontinuousdatabetweentwogroups,andtheMann-WhitneyUtestwasusedforcomparisonofnon-normallydistributedcontinuousdatabetweentwogroups;thechi-squaredtestortheFisher,sexacttestwasusedforcomparisonofcategoricaldatabetweengroups.TemultivariateLogisticregressionanalysiswasusedtoidentifytheindependentriskfoctorsforesophagogastricvaricealbleedinginpatientswithliverdrrosisandestablishanomogrampredictivemodel.ResultsThemalepatientsaccountedfor75.00%inthebleedinggroupand40.68%inthenor>bleedinggroup,andtherewasasignificantdifferenceinsexcompositionbetweenthetwogroups(2=14.384,P<0,001).ChronichepatitisBwasthemainetiologyinboththebleedinggroupandthenonedinggroup(5333%vs38.98%),andtherewasnosignificantdifferenceincompositionratiobetweenthetwogrps(/=2464,P=OlI6).Comparedwiththenon-bleedinggroup,thebleedinggrouphadasignificantlyhigheractivityofAT-11IA(/=3329,P=0.001)andsignificantlylowerlevelsofPLT,TBiI,Ca,TC,andTT(allP<0,05).ThereweresignificantdifferencesinAPRIandPALBIbetweenthetwogroups(/=6.175and19.532,bothP<0.05).ThebinarylogisticregressianalysisshowedthatAPRI(oddsratioOR=0.309,95%confidenceintervalCl:0.109-0.881jP=O.028),PALBI(Off=7.667,95%C:2.00529327,P=O.003)lCa(OR=0.001,95%C:0.0000.141fP=0,007),TC(Off=0.469,95%C:0226-0.973,P=0,042),and(OR=O.599,95%C:0.4330.830,P=0.002)wereindependentinfluencingfactorsforesophagogastricvaricealbleedinginlivercirrhosis.Anomogrammodelwasestablishedbasedontheabovefactorsandhadanindexofconcordanceof0.899andawell-fittedcalibrationcurve.CclusionAPRIandPALBIhaveagoodvalueinpredictingesophagogastricvaricealbleedinginpatientswithlivercirrhosis,andthenomogrammodelestablishedbasedonthisstudycanpredicttheincidencerateofesophagogastricvaricealbleedinginpatientswithlivercirrhosis.Keywords:LiverCirrhosis;EsophagealandGastricVarices;GastrointestinalHemorrhage;APRI;PALBI;NomogramsResearchfunding:NatialMorScienceandTechnologySpecialProjectofthe13f,Five-YearPlanPeriod(2017ZX10203201002-002);SuzhouHealthYouthBackboneTalent"NationalTutorialSystem,TrainingProject(20190013990009);TianqingLiverDiseaseResearchFoundation(TQGB20210134)肝硬化是由慢性肝病演化而成的严重病理阶段，主要特征包括肝弥漫性纤维化、内外血管增殖、产生假小叶等，在代偿期其临床症状不显著，失代偿期的主要特点是严重肝损伤与门静脉高压；经常伴随腹水及肝性脑病和癌变等并发症，致使多脏器衰竭，最终死亡11c食管胃底静脉曲张破裂出血存在极高的病死率，是最常见的消化系统急症之一。胃肠镜目前仍然是筛查消化道静脉曲张及评估出血风险的"金标准"，但由于其属于侵入性检查手段，在检查时会使患者产生不适感，且有可能存在麻醉意外，因此在平时的监测中有一定的局限性。因此，寻找无创性指标显得十分重要。近年来，已经开发了几种无创性指标，用于预测食管胃底静脉曲张及破裂出血，如天冬氨酸转氨酶与血小板比值指数(APRI).肝纤维化指数4(FIB-4)、King评分、血小板-白蛋白-胆红素评分(PALBI)等【W】。本研究拟评估APRI及PALBI对肝硬化并发食管胃底静脉曲张破裂出血的预测价值。1资
