基于超声内镜及临床数据预测肝硬化患者出血风险的列线图模型建立

Establishment of a nomogram model for predicting bleeding risk based on endoscopic ultrasound and clinical data among patients with liver cirrhosis

目的基于临床数据及超声内镜检查,研究其对肝硬化食管静脉曲张结扎术(EVL)后食管静脉曲张破裂出血(EVB)的预测价值。方法对400例符合人组标准的预防性EVL患者行普通内镜及超声内镜检查,监测其临床指标、镜下表现、食管周围侧支静脉、食管旁静脉、穿通静脉直径及数量等,对相关因素进行多因素Cox比例风险回归分析;基于预后相关独立因素建立列线图(nomogram)预测模型;通过一致性指数(C-index)对所得列线图进行内部验证以检查其预测精度、校正曲线评估其一致性、临床决策分析评估其临床效益。结果年龄、性别、病因、peri-ECV数量、para-ECV直径、1门静脉直径、奇静脉直径均为疾病进展的危险因素(P<0.05);并将其纳入构建列线图,内部验证所得Cindex为0.864;该模型预测出血进展的受试者操作特征曲线下面积为0.994(P<0.001),说明对疾病的预测价值高、校正曲线验证一致性俱佳。结论基于临床数据及超声内镜检查,构建的列线图预测模型对肝硬化食管静脉曲张患者进行预防性干预治疗可有效提高该人群的治疗效果,减少静脉曲张的发生、提高其生存质量,表现出良好的性能、对临床治疗决策具有一定的指导意义。

Objective To study the predictive value for esophageal variceal bleeding(EVB)after esophageal variceal ligation(EVL)based on clinical data and endoscopic ultrasound examination among patients with liver cirrhosis.Methods Routine endoscopy and endoscopic ultrasound were performed on 400 preventive EVL cases who met the enrollment criteria,and their clinical indicators,microscopic manifestations,diameter and number of peripheral collateral veins,para-esophageal veins,perforating veins,and so on were monitored.Multivariate Cox proportional hazard regression analysis was performed to determine the relevant factors.Nomogram predictive model was established based on the independent prognostic factors.Nomogram internal validation was carried out with C-index to check the prediction accuracy,calibration curve evaluation consistency,and clinical beneft evaluation for decision-making.Results Age,gender,etiology,peri-ECV number,para-ECV diameter,portal vein diameter,and azygous vein diameter were the risk factors for disease progression(P<0.05),and they were all included in the establishment of nomogram.The C-index obtained by internal validation was 0.864,and the area under the receiver operating characteristic curve(AUC)of the predicting bleeding progression model was 0.994(P<0.001),suggesting that the disease had high predictive value and the calibration curve validity had consistency.Conclusion Nomogram predictive model established based on the clinical data and endoscopic ultrasound examination is a preventive and therapeutic intervention for liver cirrhotic patients with esophageal varices,which can effectively improve the therapeutic effects of this population,reduce the EVs occurrence,and improve their quality of life.In addition,it also has an outstanding favorable performance.Therefore,it has certain guiding significance for the judgment of clinical treatment.