基线肝静脉压力梯度对接受二级预防的肝硬化患者静脉曲张再出血的预测价值。
The predictive value of baseline hepatic venous pressure gradient for variceal rebleeding in cirrhotic patients receiving secondary prevention.
作者信息
Liu Chuan, Liu Yanna, Shao Ruoyang, Wang Sining, Wang Guangchuan, Wang Lifen, Zhang Mingyan, Hou Jinlin, Zhang Chunqing, Qi Xiaolong
机构信息
Department of Hepatology Unit and Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan 250012, China.
出版信息
Ann Transl Med. 2020 Feb;8(4):91. doi: 10.21037/atm.2019.12.143.
BACKGROUND
Baseline hepatic venous pressure gradient (HVPG) has been applied for prediction of variceal rebleeding in patients after acute variceal bleeding. However, for patients receiving secondary prevention, there still lacks evidence about the predictive performance of baseline-HVPG for rebleeding. This study aims to investigate the predictive value of baseline-HVPG for variceal rebleeding in cirrhotic patients receiving secondary prevention.
METHODS
This retrospective study included 122 patients with cirrhosis accepting secondary prevention of variceal rebleeding in a university hospital. All the included patients had HVPG measurements before rebleeding and had at least 1-year follow-up after HVPG measurement unless the rebleeding occurred. The rebleeding rate in patients with different HVPG levels and time-dependent predictive performance of baseline-HVPG were analysed. A Cox regression model and P for trend were used to assess the rebleeding risk.
RESULTS
Variceal rebleeding occurred in 22 (18.0%) patients during 1-year follow-up. No significant difference was observed in rebleeding rate between patients with HVPG <16 mmHg and HVPG ≥16 mmHg (17.91% 26.41%, P=0.200). A decreasing trend was observed in area under the curve of HVPG for predicting rebleeding by time. The multivariate Cox model showed an overall decreasing trend in hazard ratio of rebleeding ( patients with HVPG <12 mmHg) for patients with 12≤ HVPG <16 mmHg, 16≤ HVPG <20 mmHg and HVPG ≥20 mmHg; besides, an increasing P for trend was observed.
CONCLUSIONS
A single baseline-HVPG measurement was insufficient for predicting rebleeding in patients with cirrhosis who received secondary prevention.
背景
基线肝静脉压力梯度（HVPG）已被用于预测急性静脉曲张出血患者的静脉曲张再出血。然而，对于接受二级预防的患者，关于基线HVPG对再出血的预测性能仍缺乏证据。本研究旨在探讨基线HVPG对接受二级预防的肝硬化患者静脉曲张再出血的预测价值。
方法
这项回顾性研究纳入了一家大学医院中122例接受静脉曲张再出血二级预防的肝硬化患者。所有纳入患者在再出血前均测量了HVPG，且在测量HVPG后至少随访1年，除非发生再出血。分析了不同HVPG水平患者的再出血率以及基线HVPG的时间依赖性预测性能。采用Cox回归模型和趋势P值评估再出血风险。
结果
在1年的随访期间，22例（18.0%）患者发生了静脉曲张再出血。HVPG<16 mmHg和HVPG≥16 mmHg的患者再出血率无显著差异（17.91%对26.41%，P = 0.200）。随着时间推移，HVPG预测再出血的曲线下面积呈下降趋势。多变量Cox模型显示，对于HVPG<12 mmHg、12≤HVPG<16 mmHg、16≤HVPG<20 mmHg和HVPG≥20 mmHg的患者，再出血风险比总体呈下降趋势；此外，趋势P值增加。
结论
单次基线HVPG测量不足以预测接受二级预防的肝硬化患者的再出血。
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