PC/SD、FIB-4指数、CTP评分、MELD评分、MELD-Na评分在预测肝硬化食管静脉曲张出血套扎术后1年内再出血的价值评估

Evaluation of PC/SD,FIB-4 index,CTP score,MELD score and MELD-Na score in the prediction of rebleeding after ligation of esophageal varices with cirrhosis in 1 year

目的 探讨并比较PC/SD、FIB-4指数、CTP评分、MELD评分、MELD-Na评分这5种评分模型对肝硬化食管静脉曲张破裂出血(esophageal variceal bleeding, EVB)行食管静脉曲张套扎术(esophageal varices ligation, EVL)术后1年内再出血的诊断价值。方法 选取从2019年2月至2021年1月在江苏省苏北人民医院消化内科首次因肝硬化EVB行EVL患者,收集其相应临床资料,以EVL术后1年内再出血为终点事件,终止随访。采用ROC曲线评估5种评分模型对EVL术后1年内再出血的预测价值,筛选出最佳预测评分模型。结果 共纳入196例肝硬化EVB行EVL患者,其中1年内再出血患者63例(32.1%)。再出血组与未再出血组在PLT、DBIL、PT、INR、脾长、门静脉主干内径、红色征阳性、食管静脉曲张严重度、PC/SD、FIB-4指数、CTP评分及分级、MELD评分及MELD-Na评分比较,差异有统计学意义(P均<0.05)。5种潜在预测模型对肝硬化EVB患者行EVL术后1年内再出血的预测均具有一定价值,相互之间具有显著相关性(P<0.01),其中CTP评分、MELD评分、MELD-Na评分、FIB-4指数相互之间呈正相关,而PC/SD与CTP评分、MELD评分、MELD-Na评分、FIB-4指数之间呈负相关。各模型AUC经正态性Z检验比较发现,PC/SD曲线下面积显著高于MELD评分、MELD-Na评分、FIB-4指数,而与CTP评分差异无统计学意义,此外,CTP评分与MELD评分、MELD-Na评分、FIB-4指数曲线下面积差异无统计学意义(P>0.05)。结论 5种潜在预测模型对肝硬化EVB患者行EVL术后1年内再出血的预测均具有一定价值,PC/SD的预测效能要优于MELD评分、MELD-Na评分、FIB-4指数;CTP评分与MELD评分、MELD-Na评分、FIB-4指数的预测效能相似。在非脾脏切除患者中,PC/SD可能是肝硬化EVB患者行EVL术后1年内再出血的最佳预测模型,值得进一步研究及推广。

Objective To explore and compare PC/SD,FIB-4 index,CTP score,MELD score and MELD-Na score in the diagnosis of rebleeding within 1 year after esophageal variceal ligation(EVL)in cirrhosis patients with esophageal variceal bleeding(EVB).Methods Patients who underwent EVL for cirrhosis for the first time in the Department of Gastroenterology,Northern Jiangsu People′s Hospital from Feb.2019 to Jan.2021 were selected.The corresponding clinical data were collected.The follow-up was terminated with rebleeding within 1 year after EVL.ROC curve was used to evaluate the predictive value of 5 scoring models for rebleeding within 1 year after EVL.The AUC values of each model were compared by normal Z test.Results A total of 196 cirrhosis patients with EVB who underwent EVL were included in this study,including 63 patients(32.1%)with rebleeding within 1 year.There were significant differences in PLT,DBIL,PT,INR,spleen length,portal main diameter,positive red sign,esophageal varicosis severity,PC/SD,FIB-4 index,CTP score and grade,MELD score and MELD-Na score between the rebleeding group and the non-rebleeding group(all P<0.05),all the 5 potential prediction models had certain value for the prediction of rebleeding within 1 year after EVL in cirrhosis patients with EVB,and were significantly correlated with each other(P<0.01),CTP score,MELD score,MELD-Na score and FIB-4 index were positively correlated with each other,while PC/SD was negatively correlated with CTP score,MELD score,MELD-Na score and FIB-4 index.The AUC of PC/SD was significantly higher than MELD score,MELD-Na score,FIB-4 index by normality Z test,but there was no significant difference compared with CTP score,and there was no significant difference between CTP score and MELD score,MELD-Na score,FIB-4 index(P>0.05).Conclusion All the five potential prediction models have certain value for the prediction of rebleeding within 1 year after EVL in cirrhosis patients with EVB.The prediction efficiency of PC/SD is better than MELD score,MELD-Na score and FIB-4 index.The prediction efficiency of CTP score is similar to MELD score,MELD-Na score and FIB-4 index.In non-splenectomy patients,PC/SD may be the best prediction model for rebleeding in patients with cirrhosis after EVL within 1 year,which is worthy of further study and promotion.