[Risk factors and construction of a nomogram model for cirrhotic portal vein thrombosis combined with esophagogastric variceal bleeding].

医学 胃肠病学 列线图 内科学 食管静脉曲张 红细胞压积 接收机工作特性 胃静脉曲张 门静脉血栓形成 单变量分析 门脉高压 肝硬化 多元分析
作者
Yanwei Shen,Z B Zhao,Xinjun Li,Limei Chen,Hong Yuan
出处
期刊:PubMed 卷期号:31 (10): 1035-1042 被引量:1
标识
DOI:10.3760/cma.j.cn501113-20220712-00377
摘要

Objective: To investigate the risk factors and construct a nomogram model for predicting the occurrence of cirrhotic portal vein thrombosis in patients combined with esophagogastric variceal bleeding (EVB). Methods: Clinical data on 416 cirrhotic PVT cases was collected from the First Hospital of Lanzhou University between January 2016 and January 2022. A total of 385 cases were included after excluding 31 cases for retrospective analysis. They were divided into an esophagogastric variceal bleeding group and a non-esophagogastric variceal bleeding group based on the clinical diagnosis. The esophagogastric variceal group was then further divided into an EVB group and a non-bleeding group. All patients underwent gastroscopy, serology, and imaging examinations. The risk factors of PVT combined with EVB were identified by univariate analysis using SPSS 26. The prediction model of cirrhotic PVT in patients combined with EVB was constructed by R 4.0.4. The prediction efficiency and clinical benefits of the model were evaluated by the C-index, area under the receiver operating characteristic curve, calibration plots, and decision curve. The measurement data were examined by a t-test or Mann-Whitney U test. The counting data were tested using the χ(2) test or the Fisher exact probability method. Results: There were statistically significant differences in the etiology, Child-Pugh grade,erythrocyte count, hematocrit, globulin, and serum lipids between the esophageal and non-esophageal varices groups (P < 0.05). There were statistically significant differences in etiology, erythrocyte count, hemoglobin, hematocrit, neutrophil percentage, total protein, globulin, albumin/globulin, urea, high-density lipoprotein cholesterol, calcium, and neutrophil lymphocyte ratio (NLR) between the EVB and non-bleeding groups (P < 0.05). Multivariate logistic regression analysis showed that etiology (OR = 3.287, 95% CI: 1.497 ~ 7.214), hematocrit (OR = 0.897, 95% CI: 0.853 ~ 0.943), and high-density lipoprotein cholesterol (OR = 0.229, 95% CI: 0.071 ~ 0.737) were independent risk factors for cirrhotic PVT patients combined with EVB. The constructed normogram model predicted the probability of bleeding in patients. The nomogram model had shown good consistency and differentiation (AUC = 0.820, 95% CI: 0.707 ~ 0.843), as verified by 10-fold cross-validation (C-index = 0.799) and the Hosmer-Lemeshow goodness of fit test (P = 0.915). The calibration plot and the decision curve suggested that the prediction model had good stability and clinical practicability. Conclusion: The risk factors for EVB occurrence include etiology, erythrocyte, hemoglobin, hematocrit, percentage of neutrophils, total protein, globulin, albumin/globulin, urea, high-density lipoprotein cholesterol, calcium, and NLR in patients with cirrhotic liver. The constructed prediction model has good predictive value, and it can provide a reference for medical personnel to screen patients with high bleeding risk for targeted treatment.目的: 探讨肝硬化患者门静脉血栓(PVT)合并食管胃底静脉曲张破裂出血(EVB)的危险因素,构建预测肝硬化PVT患者发生EVB的列线图模型。 方法: 收集兰州大学第一医院2016年1月至2022年1月的416例肝硬化PVT患者临床资料,排除31例后,共纳入385例进行回顾性分析。根据临床诊断分为食管胃底静脉曲张组与非食管胃底静脉曲张组;食管胃底静脉曲张组再分为EVB组与非出血组。所有患者行胃镜、血清学及影像学检查,通过SPSS 26进行单因素分析,得出PVT合并EVB的危险因素;通过R 4.0.4建立肝硬化患者PVT合并EVB的预测模型,并采用一致性指数(C-index)、受试者操作特征曲线下面积、校准图、决策曲线评估模型的预测效能及临床效益。计量资料采用t检验或Mann-Whitney U检验;计数资料采用χ(2)检验或Fisher精确概率法检验。 结果: 食管胃底静脉曲张组与非食管胃底静脉曲张组中患者的病因、Child-Pugh分级、红细胞计数、红细胞压积、球蛋白、血脂指标的差异具有统计学意义(P值均< 0.05)。EVB组与非出血组中患者的病因、红细胞计数、血红蛋白、红细胞压积、中性粒细胞百分比、总蛋白、球蛋白、白蛋白/球蛋白比值、尿素、高密度脂蛋白胆固醇、钙、中性粒细胞淋巴细胞比值(NLR)的差异具有统计学意义(P值均< 0.05)。多因素logistic回归分析显示病因(乙型病毒性肝炎与其他的OR = 3.287,95% CI:1.497~7.214)、红细胞压积(OR = 0.897,95% CI:0.853~0.943)、高密度脂蛋白胆固醇(OR = 0.229,95% CI:0.071~0.737)是肝硬化PVT患者EVB的独立危险因素,并基于该模型构建列线图,用于预测患者的出血概率。列线图表现出良好的一致性和区分度(曲线下面积为0.820,95% CI:0.707~0.843),并经10折交叉验证进行内部验证(C-index = 0.799)和Hosmer-Lemeshow拟合优度检验(P = 0.915),校准曲线提示预测模型具有良好稳定性,决策曲线提示具有临床实用性。 结论: 肝硬化PVT患者发生EVB的危险因素有病因、红细胞计数、血红蛋白、红细胞压积、中性粒细胞百分比、总蛋白、球蛋白、白蛋白/球蛋白比值、尿素、高密度脂蛋白胆固醇、钙、NLR,建立的预测模型具有良好的预测价值,可为医务人员筛查高出血风险患者及针对性治疗提供参考依据。.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
陈pc发布了新的文献求助10
1秒前
1秒前
Sli完成签到,获得积分10
2秒前
郑砚桐发布了新的文献求助10
2秒前
手拿大炮完成签到,获得积分10
2秒前
辛勤的毛毛完成签到 ,获得积分10
2秒前
9528保护我完成签到,获得积分10
3秒前
3秒前
归尘发布了新的文献求助10
3秒前
共享精神应助alho采纳,获得10
3秒前
5秒前
5秒前
Lucas应助Hazel采纳,获得10
6秒前
曾无忧应助奋斗的海豚采纳,获得10
7秒前
Xin_Tang完成签到,获得积分10
7秒前
李健应助qqq采纳,获得10
7秒前
7秒前
赫若魔应助Hhd采纳,获得10
7秒前
8秒前
英姑应助扯淡儿采纳,获得10
8秒前
8秒前
清脆语海发布了新的文献求助10
9秒前
李健应助合适阑悦采纳,获得10
9秒前
浮游应助细心的靖巧采纳,获得10
9秒前
明亮的寻芹完成签到,获得积分10
9秒前
Kiki完成签到 ,获得积分10
10秒前
橙子发布了新的文献求助20
10秒前
einspringen发布了新的文献求助10
10秒前
xiao发布了新的文献求助10
11秒前
打打应助吱吱吱吱在采纳,获得10
11秒前
十九完成签到,获得积分10
11秒前
Amos完成签到,获得积分10
12秒前
Xin_Tang发布了新的文献求助30
12秒前
左友铭发布了新的文献求助10
12秒前
xinxinqi完成签到 ,获得积分10
12秒前
12秒前
13秒前
13秒前
罐罐儿应助拼搏的金针菇采纳,获得10
13秒前
快乐一下发布了新的文献求助20
14秒前
高分求助中
(应助此贴封号)【重要!!请各用户(尤其是新用户)详细阅读】【科研通的精品贴汇总】 10000
SOFT MATTER SERIES Volume 22 Soft Matter in Foods 1000
Zur lokalen Geoidbestimmung aus terrestrischen Messungen vertikaler Schweregradienten 1000
Storie e culture della televisione 500
Selected research on camelid physiology and nutrition 500
《2023南京市住宿行业发展报告》 500
Food Microbiology - An Introduction (5th Edition) 500
热门求助领域 (近24小时)
化学 医学 生物 材料科学 工程类 有机化学 内科学 生物化学 物理 计算机科学 纳米技术 遗传学 基因 复合材料 化学工程 物理化学 病理 催化作用 免疫学 量子力学
热门帖子
关注 科研通微信公众号,转发送积分 4884137
求助须知:如何正确求助?哪些是违规求助? 4169517
关于积分的说明 12937642
捐赠科研通 3929850
什么是DOI,文献DOI怎么找? 2156330
邀请新用户注册赠送积分活动 1174727
关于科研通互助平台的介绍 1079546