血清sCD163对食管胃静脉曲张内镜下治疗后再出血风险的预测价值

Predictive value of serum sCD163 for the risk of rebleeding after endoscopic treatment of esophageal and gastric varices

目的通过对食管胃静脉曲张内镜下治疗患者术前血清可溶性血红蛋白清道夫受体163(sCD163)进行检测,结合治疗达标后18个月随访期内有无再出血情况,分析术前血清sCD163水平对食管胃静脉曲张内镜下治疗后再出血风险的预测价值。方法选取2019年1月至2022年6月在南通市第三人民医院进行肝硬化食管胃静脉曲张二级预防内镜下治疗的203例患者作为研究对象,在患者首次内镜下治疗前进行血清sCD163检测,经过1~3次内镜下治疗后复查胃镜,确认治疗达标后进入随访阶段,随访期内确认有无再出血情况,并根据出血情况分为出血组和未出血组。采用多因素Logistic回归分析再出血的危险因素。采用受试者工作特征(ROC)曲线分析血清sCD163对再出血风险的预测价值。结果未出血组和出血组患者血小板计数(PLT)、凝血酶原时间(PT)、门静脉宽度、sCD163水平比较,差异均有统计学意义(P<0.05);出血组和未出血组患者性别、年龄、丙氨酸转氨酶(ALT)、总胆红素(TBIL)、清蛋白(ALB)、有无腹水等临床资料比较,差异均无统计学意义(P>0.05)。将单因素分析差异有统计学意义的4项指标(PLT、PT、门静脉宽度、sCD163)纳入多因素Logistic回归分析,结果显示,仅血清sCD163水平升高是再出血的危险因素(P<0.05),其OR值为3.684。ROC曲线分析结果显示,血清sCD163预测治疗后再出血风险的最佳截断值为3.66 mg/L,灵敏度为0.746,特异度为0.833,曲线下面积为0.840。高、低sCD163组性别、年龄、PLT、ALT、TBIL、ALB等临床资料比较,差异均无统计学意义(P>0.05)。结论术前血清sCD163是肝硬化食管胃静脉曲张内镜下治疗后再出血风险的独立预测因子,术前血清sCD163水平检测对二级预防治疗方式的选择有一定指导意义。

Objective To detect the serum soluble hemoglobin scavenger receptor 163(sCD163)in patients with esophageal and gastric varices before endoscopic treatment,and to investigate whether there was rebleeding in the follow-up period of 18 months after treatment.The predictive value of preoperative serum sCD163 level for the risk of rebleeding after endoscopic treatment of esophagogastric varices was analyzed.Methods A total of 203 patients with liver cirrhosis who underwent secondary preventive endoscopic treatment for esophagogastric varices in the Third People′s Hospital of Nantong from January 2019 to June 2022 were selected as the research objects.Serum sCD163 was detected before the first endoscopic treatment.After 1-3 times of endoscopic treatment,gastroscopy was reexamined to confirm that the treatment reached the standard and entered the follow-up phase,and patients were divided into bleeding group and non bleeding group according to the bleeding situation.Multivariate Logistic regression was used to analyze the risk factors of rebleeding.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum sCD163 for the risk of rebleeding.Results There were significant differences in platelet count(PLT),prothrombin time(PT),portal vein width and sCD163 level between the non-bleeding group and the bleeding group(P<0.05).There was no significant difference in clinical data such as gender,age,alanine aminotransferase(ALT),total bilirubin(TBIL),albumin(ALB)and ascites between the non-bleeding group and the bleeding group(P>0.05).Single factor analysis of the difference was statistically significant 4 indicators(PLT,PT,portal vein width,sCD163)into the multiariable Logistic regression analysis,the results show that only sCD163 serum levels was a risk factor for bleeding again(P<0.05),OR value was 3.684.The results of ROC curve analysis showed that the best cut-off value of serum sCD163 for predicting the risk of rebleeding after treatment was 3.66 mg/L,the sensitivity was 0.746,the specificity was 0.833,and the area under the curve was 0.840.There was no significant difference in gender,age,PLT,ALT,TBIL,ALB and other clinical data between the high and low sCD163 groups(P>0.05).Conclusion Preoperative serum sCD163 is an independent predictor of rebleeding risk after endoscopic treatment of esophagogastric varices in liver cirrhosis.The detection of preoperative serum sCD163 level has certain guiding significance for the selection of secondary prevention treatment methods.