治疗前血小板与白蛋白比值对肝硬化伴食管和胃静脉曲张出血内镜治疗短期预后的预测价值

Predictive value of pre-treatment platelet-to-albumin ratio in short-term prognosis of endoscopic treatment for cirrhosis with esophageal and gastric variceal bleeding

目的探讨治疗前血小板与白蛋白比值(PAR)对肝硬化伴食管和胃静脉曲张出血(EGVB)患者内镜治疗短期预后的预测价值。方法回顾性分析2019年1月至2022年4月蚌埠市第一人民医院行内镜治疗的195例肝硬化伴EGVB患者的临床资料,根据治疗前血小板计数和白蛋白计算PAR。采用单因素和多因素Cox回归分析影响患者6周再出血和死亡的独立危险因素,绘制受试者工作特征(ROC)曲线评价PAR对再出血和死亡的预测价值,采用Kaplan-Meier生存曲线评价不同PAR患者再出血率和生存率。结果195例患者中6周内再出血36例,非再出血159例;6周内死亡15例,存活180例。再出血组血小板计数、PAR低于非再出血组[74.0(66.5,88.8)×10^(9)/L比98.0(85.0,111.0)×10^(9)/L、2.48(2.18,2.78)比3.35(2.81,4.04)],直接胆红素、三酰甘油、丙氨酸氨基转移酶、凝血酶原时间、病死率高于非再出血组[18.5(14.0,23.8)μmol/L比16.0(11.0,20.0)μmol/L、(4.73±2.52)mmol/L比(3.94±1.65)mmol/L、36.0(27.0,46.0)U/L比21.0(13.3,33.0)U/L、(14.78±1.63)s比(13.47±0.87)s、36.11%(13/36)比1.26%(2/159)],差异有统计学意义(P<0.05)。多因素Cox回归结果显示,PAR、丙氨酸氨基转移酶是影响肝硬化伴EGVB患者6周再出血的主要危险因素,PAR是影响患者6周死亡的主要危险因素(均P<0.05)。PAR预测6周再出血和死亡的曲线下面积分别为0.876、0.776,最佳临界值分别为2.94和2.71,特异度分别为69.8%和72.2%,灵敏度分别为94.4%和73.3%。以PAR预测再出血最佳临界值分组,PAR≤2.94组6周再出血率高于PAR>2.94组,差异有统计学意义(χ^(2)=36.88,P<0.01);以PAR预测死亡最佳临界值分组,PAR≤2.71组6周病死率高于PAR>2.71组,差异有统计学意义(χ^(2)=16.44,P<0.01)。结论治疗前PAR可作为接受内镜治疗的肝硬化伴EGVB患者6周内再出血和死亡的预测指标。

Objective To explore the predictive value of pre-treatment platelet-to-albumin ratio(PAR)in short-term prognosis of endoscopic treatment for cirrhosis with esophageal and gastric variceal bleeding(EGVB).Methods By retrospective analysis method,the clinical data of 195 cirrhotic patients with EVGB from January 2019 to April 2022 treatment at Bengbu First People′s Hospital were collected and analyzed.The PAR was calculated according to platelet count and albumin.The independent risk factors that affecting 6-week rebleeding and death were analyzed by univariate and multivariate Cox regression,the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of PAR for rebleeding and death,and Kaplan-Meier survival analysis was used to evaluate the rebleeding rate and survival rate of patients with different PAR ratios.Results Among 195 patients,36 patients were rebleeding and 159 patients were non-rebleeding within 6 weeks;while 15 cases died and 180 cases survived.The platelet count,PAR in the rebleeding group were lower than those in the non-rebleeding group,the direct bilirubin,triglyceride,alanine transaminase,prothrombin time and mortality in the rebleeding group were higher than those in the non-rebleeding group:74.0(66.5,88.8)×10^(9)/L vs.98.0(85.0,111.0)×10^(9)/L,2.48(2.18,2.78)vs.3.35(2.81,4.04),18.5(14.0,23.8)μmol/L vs.16.0(11.0,20.0)μmol/L,(4.73±2.52)mmol/L vs.(3.94±1.65)mmol/L,36.0(27.0,46.0)U/L vs.21.0(13.3,33.0)U/L,(14.78±1.63)s vs.(13.47±0.87)s,36.11%(13/36)vs.1.26%(2/159),there were statistical differences(P<0.05).Cox multivariate regression showed that PAR,alanine transaminase were the independent risk factors for the rebleeding(P<0.05),PAR was the independent risk factor for the death within 6 weeks(P<0.05).The area under the curve(AUC)of PAR for predicting 6-week rebleeding and death was 0.876,0.776,the cut-off was 2.94,2.71,the specificity was 69.8%,72.2%,the sensitivity was 94.4%,73.3%,respectively.According to the cut-off of PAR to predict rebleeding,the 6-week rebleeding rate in the PAR≤2.94 group was higher than that in the PAR>2.94 group(χ^(2)=36.88,P<0.01).According to the cut-off of PAR to predict death,the 6-week mortality rate in the PAR≤2.71 group was higher than in the PAR>2.71 group(χ^(2)=16.44,P<0.01).Conclusions PAR can be used as a predictor for rebleeding and death within 6 weeks of EGVB in cirrhotic patients.