Wu Y, Chen M, Huang M, Liao G, Tang S, Zheng H, Li Y, Peng B, Zheng X, Pan S, Hou J, Chen B
First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China.
Department of Gastroenterology and Hepatology of First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510000, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2021 Dec 20;41(12):1822-1827. doi: 10.12122/j.issn.1673-4254.2021.12.10.
To assess the value of the purple sign for predicting long-term rebleeding events in cirrhotic patients following endoscopic selective varices devascularization.
We retrospectively analyzed the clinical data of 97 patients with liver cirrhosis, who had a history of gastroesophageal variceal bleeding and underwent endoscopic selective varices devascularization. Thirty-two of the patients showed purple sign after endoscopic treatment. We used propensity score matching (PSM) to minimize the selection bias of the patients (purple sign vs no purple sign) and reduce the intergroup differences of clinical characteristics. The primary outcome measure of this study was cumulative rebleeding events after endoscopic selective varices devascularization.
The 1-year rebleeding rate (27.0% 36.7%) or 6-month rebleeding rate (10.9% 26.9%) following endoscopic treatment was not significantly different between the purple sign group and no purple sign group before PSM (=0.2385). But after PSM, the 1-year rebleeding rate (28.2% 56.4%) and 6-month rebleeding rate (5.0% 37.0%) were significantly lower in the purple sign group than in the no purple sign group (=0.0304).
The presence of purple sign indicates a lower risk of rebleeding after endoscopic treatment of cirrhotic gastroesophageal varices and a potentially favorable treatment response after endoscopic therapy, thus providing a clinical indicator for stratification of the patients for sequential endoscopic sessions.
评估紫色征在预测肝硬化患者内镜下选择性静脉曲张断流术后长期再出血事件中的价值。
我们回顾性分析了97例有食管胃静脉曲张出血病史且接受内镜下选择性静脉曲张断流术的肝硬化患者的临床资料。其中32例患者在内镜治疗后出现紫色征。我们采用倾向得分匹配法（PSM）以尽量减少患者（有紫色征组与无紫色征组）的选择偏倚，并减少临床特征的组间差异。本研究的主要结局指标是内镜下选择性静脉曲张断流术后的累积再出血事件。
在PSM之前，紫色征组和无紫色征组内镜治疗后的1年再出血率（27.0%对36.7%）或6个月再出血率（10.9%对26.9%）无显著差异（P=0.2385）。但PSM后，紫色征组的1年再出血率（28.2%对56.4%）和6个月再出血率（5.0%对37.0%）显著低于无紫色征组（P=0.0304）。
紫色征的出现表明肝硬化食管胃静脉曲张内镜治疗后再出血风险较低，且内镜治疗后可能有较好的治疗反应，从而为后续内镜治疗患者的分层提供了一个临床指标。
