Siringo S, Bolondi L, Gaiani S, Sofia S, Zironi G, Rigamonti A, Di Febo G, Miglioli M, Cavalli G, Barbara L
Patologia Medica II, Università di Bologna, Italy.
Hepatology. 1994 Jul;20(1 Pt 1):66-73. doi: 10.1016/0270-9139(94)90135-x.
We followed 87 cirrhotic patients with esophageal varices and without previous hemorrhage for a mean period of 24 mo to prospectively evaluate the occurrence of variceal bleeding within (early) or after (late) 6 mo from entry and the contribution of portal Doppler ultrasound parameters to the prediction of early and late hemorrhage. Clinical, biochemical, endoscopic and portal Doppler ultrasound parameters were recorded at entry. Variceal bleeding occurred in 22 patients (25.3%). Nine (40.9%) bled within the first 6 mo. Cox regression analysis identified variceal size, cherry-red spots, serum bilirubin and congestion index of the portal vein (the ratio of portal vein [cross-sectional area] and portal blood flow velocity) as the only independent predictors of first variceal hemorrhage. Discriminant analysis was used to find the prognostic index cut off points to identify patients who bled within 6 mo (prognostic group 1) or after 6 mo (prognostic group 2) or remained free of bleeding (prognostic group 3). The cumulative proportion of patients correctly classified was 73% in prognostic group 1, 47% in prognostic group 2 and more than 80% in prognostic group 3. The addition of Doppler ultrasound flowmetry to clinical, biochemical and endoscopic parameter only improved the classification of patients with early bleeding.
我们对87例患有食管静脉曲张且既往未发生出血的肝硬化患者进行了平均24个月的随访，以前瞻性评估从入组起6个月内（早期）或6个月后（晚期）静脉曲张出血的发生情况，以及门静脉多普勒超声参数对早期和晚期出血预测的作用。入组时记录临床、生化、内镜及门静脉多普勒超声参数。22例患者（25.3%）发生了静脉曲张出血。9例（40.9%）在最初6个月内出血。Cox回归分析确定静脉曲张大小、樱桃红点、血清胆红素及门静脉充血指数（门静脉[横截面积]与门静脉血流速度之比）为首次静脉曲张出血的唯一独立预测因素。采用判别分析来确定预后指数的截断点，以识别在6个月内出血的患者（预后组1）、6个月后出血的患者（预后组2）或未发生出血的患者（预后组3）。预后组1中正确分类患者的累积比例为73%，预后组2中为47%，预后组3中超过80%。仅将多普勒超声血流测定法加入临床、生化和内镜参数中，仅改善了早期出血患者的分类。
