MELD-Na评分联合NLR预测肝硬化食管胃静脉曲张破裂出血后再出血的临床价值

Clinical Value of MELD-Na Score Combined with NLR in Predicting Rebleeding after Esophageal and Gastric Varices Rupture and Hemorrhage in Cirrhosis

目的探讨终末期肝病模型与血钠(MELD-Na)评分联合中性粒细胞计数/淋巴细胞计数比值(NLR)预测肝硬化食管胃静脉曲张破裂出血(EGVB)后再出血的临床价值。方法选取2019年1月-2022年8月我院收治的肝硬化EGVB患者179例纳入研究,入院当日为观察起点,观察3个月内患者再出血情况,将其分为再出血组(n=42)和未出血组(n=137)。通过多因素Logistic回归分析模型分析影响肝硬化EGVB患者3个月内发生再出血的危险因素,并绘制受试者工作特征曲线(ROC)评估MELD-Na评分联合NLR对肝硬化EGVB患者3个月内发生再出血的预测价值。结果3个月内患者再出血率23.46%。再出血组腹水中轻和重度占比、肝性脑病占比、Child C级占比及NLR、MELD-Na评分均高于未出血组(P<0.05);再出血组门静脉流速、无腹水患者占比、Child A级和B级占比、HB水平、血钠水平均低于未出血组(P<0.05)。Logistic回归分析显示,低门静脉流速、高NLR、高MELD-Na评分及Child分级C级均是影响EGVB患者发生再出血的危险因素(P<0.05)。ROC曲线显示,NLR联合MELD-Na评分预测肝硬化EGVB患者3个月再出血的AUC(95%CI)为0.888(0.832~0.930),高于二者单独预测的AUC(95%CI)为0.761(0.692~0.822)、0.853(0.792~0.901),且联合预测的特异度、准确度高于单项指标(P<0.05)。结论MELD-Na评分和NLR水平高均是影响肝硬化EGVB患者再出血的危险因素,且二者联合应用对预后再出血的评估有重要参考价值。

Objective To investigate the clinical value of end-stage liver disease model and MELD-Na score combined with neutrophil count/lymphocyte count ratio(NLR)in predicting bleeding after esophageal and gastric variceal rupture hemorrhage(EGEG VB)in cirrhosis.Methods 179 cases of liver cirrhosis patients with EGEG VB admitted to our hospital from January 2019 to August 2022 were included in the study.The starting point was the admission day.Rebleeding within 3 months was observed,and the patients were divided into rebleeding group(n=42)and non-bleeding group(n=137).Multivariate Logistic regression analysis model was used to analyze the risk factors for rebleeding within 3 months in patients with EGEG VB in liver cirrhosis,and receiver operating characteristic curve(ROC)was drawn to evaluate the predictive value of MELD-Na score combined with NLR in patients with EGEG VB in liver cirrhosis.Results The rate of rebleeding within 3 months was 23.46%.The proportion of mild and severe ascites,the proportion of hepatic encephalopathy,the proportion of Child C grade and the score of NLR and MELD-Na in rebleeding group were higher than those in non-bleeding group(P<0.05).The rate of portal vein flow,the proportion of patients without ascites,the proportion of Child A and B,the level of HB and the level of sodium in the rebleeding group were all lower than those in the non-bleeding group(P<0.05).Logistic regression analysis showed that low portal vein flow velocity,high NLR,high MELD-Na score and Child grade C were all risk factors for rebleeding in EGEG VB patients(P<0.05).ROC curve showed that the AUC(95%CI)of NLR combined with MELD-Na score to predict rebleeding at 3 months in patients with EGEG VB in cirrhosis was 0.888(0.832-0.930).The AUC(95%CI)of the combined prediction were 0.761(0.692~0.822)and 0.853(0.792~0.901),and the specificity and accuracy of the combined prediction were higher than that of the single index(P<0.05).Conclusion High MELD-Na score and NLR level are both risk factors for rebleeding in patients with liver cirrhosis with EGEG VB,and their combined application is of important reference value for the evaluation of prognosis for rebleeding.