消化道出血行内镜治疗后再出血影响因素分析及列线图预测模型构建-现代医学

消化道出血行内镜治疗后再出血影响因素分析及列线图预测模型构建

单位：1. 成都市第三人民医院蒲江医院·浦江县人民医院消化内科, 四川成都 611630;
2. 成都市第三人民医院消化内科, 四川成都 610037

分类号：R573.2

出版年·卷·期（页码）：2023·51·第八期（1033-1042）

摘要：

目的：分析消化道出血行内镜治疗后再出血的危险因素并建立列线图预测模型。方法：收集接受内镜治疗的357例消化道出血患者的资料并进行回顾性分析，将纳入的患者按照7 ∶ 3分为建模组(250例)及验证组(107例)。建模组根据患者是否再出血分为发生组(74例)和未发生组(176例)，对建模组患者资料行单因素及多因素Logistic回归分析，并根据消化道出血行内镜治疗后发生再出血的影响因素分析结果建立列线图预测模型,绘制校准曲线、受试者工作特征(ROC)曲线对模型的有效性及区分度进行评估。结果：单因素分析结果显示，有无休克、出血病变直径、Forrest分级、出血量、血尿素氮、血红蛋白、血小板、凝血酶原时间、Rockall危险评分、Glasgow-Blatchford评分为影响消化道出血行内镜治疗后再出血的因素(P<0.05)；多因素Logistic回归分析显示，休克、Forrest分级、出血量、血尿素氮、血红蛋白、血小板、凝血酶原时间为消化道出血行内镜治疗后再出血的危险因素(P<0.05)；校准曲线结果显示，建模组χ²=7.242，P=0.511；验证组χ²=7.008，P=0.536；ROC曲线结果显示，建模组ROC曲线下面积为0.880，灵敏度为89.19%，特异度为78.41%；验证组ROC曲线下面积为0.837，灵敏度为81.25%，特异度为77.52%。结论：消化道出血行内镜治疗后再出血的危险因素为休克、Forrest分级、出血量、血尿素氮、血红蛋白、血小板、凝血酶原时间，建立的列线图预测模型区分度及有效性较好，能够作为早期预测消化道出血行内镜治疗后发生再出血的工具。

Objective: To analyze the risk factors of rebleeding after endoscopic treatment of gastrointestinal bleeding, and to establish a nomogram prediction model. Methods: The data of 357 patients with gastrointestinal bleeding who received endoscopic treatment were collected for retrospective analysis, and the included patients were divided into modeling group(250 cases) and validation group(107 cases) according to 7∶3. The modeling group was divided into occurrence group(74 cases) and non-occurrence group(176 cases) according to whether the patient had rebleeding. Univariate and multivariate Logistic regression analyses were performed on the data of the patients in the modeling group, and a nomogram prediction model was established based on the analysis results of the influencing factors of rebleeding after endoscopic treatment of gastrointestinal bleeding. Calibration curve and ROC curve were drawn to evaluate the validity and discrimination of the model. Results: Univariate analysis showed that shock, bleeding lesion diameter, Forrest grading, blood loss, blood urea nitrogen, hemoglobin, platelet, prothrombin time, Rockall risk score and Glasgow-Blatchford score were the factors affecting gastrointestinal bleeding after endoscopic treatment(P<0.05); multivariate Logistic regression analysis showed that shock, Forrest grade, bleeding volume, blood urea nitrogen, hemoglobin, platelets, and prothrombin time were the risk factors of rebleeding after endoscopic treatment(P<0.05). The calibration curve results showed that the modeling group χ²=7.242, P=0.511; the validation group χ²=7.008, P=0.536; the ROC curve results showed that the area under the ROC curve of the modeling group was 0.880, the sensitivity was 89.19%, and the specificity was 78.41%; the area under the ROC curve of the validation group was 0.837, the sensitivity was 81.25%, and the specificity was 77.52%. Conclusion: The risk factors affecting rebleeding after endoscopic treatment for gastrointestinal bleeding are shock, Forrest grade, bleeding volume, blood urea nitrogen, hemoglobin, platelets, and prothrombin time. The established nomogram prediction model has good discrimination and validity, and can be used as a tool for early prediction of rebleeding after endoscopic treatment for gastrointestinal bleeding.

参考文献：

[1] 林芬,陈崧,梁锦云.内镜治疗在老年急性非静脉曲张性上消化道出血中的应用[J].深圳中西医结合杂志,2019,29(23):148-149.
[2] 涂霁韬,薛思军.奥美拉唑联合卡络磺钠治疗上消化道出血的疗效及安全性分析[J].中国中西医结合消化杂志,2020,28(11):881-884.
[3] MIRZAALI M,CARRASCO A C,MUNDRE P,et al.Recent advances in the management of acute upper gastrointestinal bleeding[J].Gastrointest Nurs,2020,18(6):16-23.
[4] PATEL R,MANN S.Acute upper gastrointestinal bleeding:endoscopic assessment and treatment[J].Gastrointest Nurs,2020,18(1):26-35.
[5] 王其立.急性非静脉曲张性上消化道出血的药物与内镜下治疗的临床应用进展[J].中国处方药,2021,19(12):167-168.
[6] 张华兵.内镜下钛夹止血及注射止血治疗急性上消化道出血的效果[J].中国实用医刊,2021,48(12):63-65.
[7] LAI Y,RONG J,ZHU Z,et al.Risk factors for rebleeding after emergency endoscopic treatment of dieulafoy lesion[J].Can J Gastroenterol Hepatol,2020,2020(1):1-8.
[8] HUSSEIN M,ALZOUBAIDI D,SERNA A,et al.Outcomes of hemospray therapy in the treatment of intraprocedural upper gastrointestinal bleeding post-endoscopic therapy[J].United European Gastroenterol J,2020,8(10):1155-1162.
[9] 林海凤.消化内镜治疗非静脉曲张性上消化道出血后再出血的危险因素临床分析[J].中外医疗,2021,40(35):24-27.
[10] 郭雅丽,徐宝宏,刘贤,等.食管静脉曲张内镜治疗术后早期再出血的危险因素分析[J].中华消化内镜杂志,2018,35(2):89-93.
[11] 何帅,王妍.香砂六君子汤加味联合消化内镜治疗非静脉曲张性上消化道出血及对胃肠功能紊乱的影响[J].中国中西医结合消化杂志,2020,28(3):219-222.
[12] 冯鹏远,王亚飞.62例消化道出血患儿消化内镜检查结果分析[J].临床医学,2022,42(9):48-49.
[13] 秦仁坤,耿雷辉.消化性溃疡出血患者内镜治疗后再出血的影响因素分析[J].临床医学研究与实践,2021,6(29):17-19.
[14] 高明军,杨斌,杨传春,等.结肠息肉内镜切除术后并发消化道出血的危险因素分析与预测模型建立[J].现代医学,2020,48(1):97-102.
[15] 孙雯,邓全军.非静脉曲张性上消化道出血患者在消化内镜治疗后复发的影响因素分析[J].国际生物医学工程杂志,2021,44(5):379-382,387.
[16] 周思素.上消化道出血内镜治疗后再出血的影响因素[J].临床医学,2022,42(5):24-26.
[17] 丁娟,马志杰,沙嫚.上消化道出血病人消化内镜治疗后再出血风险预测模型的构建[J].全科护理,2021,19(33):4746-4749.
[18] 秦仁坤,耿雷辉.消化性溃疡出血患者内镜治疗后再出血的影响因素分析[J].临床医学研究与实践,2021,6(29):17-19.
[19] 张春雨.凝血酶原时间和血小板检验对诊断肝硬化疾病的临床应用效果[J].当代医学,2021,27(23):31-33.
[20] 赵亚笙,林栓琴.上消化道出血患者经消化内镜治疗后再出血的相关因素及护理对策[J].山西医药杂志,2020,49(15):2071-2073.
[21] 孙喜斌,张玉虹,左路广,等.血清IL-6与红细胞分布宽度联合检测对上消化道再出血的预测价值[J].山东医药,2020,60(19):50-53.
[22] 张吉桂,周翔禹.消化内镜下不同止血夹治疗上消化道出血的疗效及对白蛋白、血红蛋白和血小板水平的影响[J].中国内镜杂志,2021,27(2):76-82.
[23] 高境蔚,李罗红,欧艳,等.消化道出血行内镜治疗后发生早期再出血的危险因素分析[J].中国内镜杂志,2020,26(2):6-10.
[24] 杨茉莉.影响急性上消化道出血患者预后的高危因素分析[J].现代诊断与治疗,2019,30(10):1712-1713.
[25] JIANG L Q,YE B X,WANG M F,et al.Acid exposure in patients with gastroesophageal reflux disease is associated with esophageal dysmotility[J].J Dig Dis,2019,20(2):73-77.
[26] 邢一鸣,余晓露.消化内镜治疗上消化道出血后再出血患者的相关危险因素研究[J].实用妇科内分泌电子杂志,2020,7(12):188-189.
[27] 庞秀峰,石斌,王缓缓,等.老年急性上消化道出血合并感染的临床特点与预后分析[J].实用临床医药杂志,2020,24(22):32-40.
[28] 刘邦喜,王小泽,晏玉玲,等.经导管动脉栓塞治疗急性非曲张静脉上消化道出血的疗效分析[J].四川大学学报(医学版),2022,53(3):398-403.
[29] 李亚岭,巴黎,罗建平.消化内镜治疗上消化道出血后再出血的危险因素分析[J].中国处方药,2021,19(1):175-176.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录