Zoli M, Merkel C, Magalotti D, Marchesini G, Gatta A, Pisi E
Istituto di Clinica Medica Generale e Terapia Medica, University of Bologna, Italy.
Hepatology. 1996 Nov;24(5):1047-52. doi: 10.1053/jhep.1996.v24.pm0008903373.
The aim of this study was to prospectively evaluate the usefulness of the Italian Liver Cirrhosis Project (ILCP) classification of esophageal varices, together with the gastric features of portal hypertension, in predicting the first upper gastrointestinal bleeding in cirrhosis. The efficiency of these endoscopic parameters in predicting bleeding was also compared with the efficiency of the North Italian Endoscopic Club (NIEC) index. Three hundred forty-four cirrhotic patients with esophageal varices but without any previous bleeding were enrolled in the study. The following endoscopic parameters of esophageal varices were recorded: location, size, occupancy, blue tone, and red color signs. Gastric varices were graded as absent or present, while congestive gastropathy was considered as absent, mild to moderate, or severe. All patients were followed until the first upper gastrointestinal bleeding and/or death, or for at least 24 months. No patient received any treatment to prevent bleeding. Sixty-five patients bled from the upper gastrointestinal tract during the study. Univariate analysis showed that all endoscopic parameters were predictors of bleeding. According to multivariate analysis (Cox's model), size, gastric varices and congestive gastropathy were the only independent predictors of bleeding, and the following prognostic index (PI) was developed: PI = (size x 0.0395) + (congestive gastropathy x 0.878) + (gastric varices x 0.705). This index, which was validated using a split-sample technique, and which appears to be superior to the NIEC index in predicting bleeding, may be useful in decision making for primary prophylaxis.
本研究的目的是前瞻性评估意大利肝硬化项目（ILCP）食管静脉曲张分类以及门静脉高压的胃部特征在预测肝硬化患者首次上消化道出血方面的实用性。还将这些内镜参数预测出血的效率与北意大利内镜俱乐部（NIEC）指数的效率进行了比较。344例有食管静脉曲张但既往无出血史的肝硬化患者纳入研究。记录了以下食管静脉曲张的内镜参数：位置、大小、占据情况、蓝色色调和红色征。胃静脉曲张分为无或有，而充血性胃病分为无、轻度至中度或重度。所有患者均随访至首次上消化道出血和/或死亡，或至少随访24个月。没有患者接受任何预防出血的治疗。65例患者在研究期间发生上消化道出血。单因素分析显示所有内镜参数均为出血的预测因素。根据多因素分析（Cox模型），大小、胃静脉曲张和充血性胃病是出血的唯一独立预测因素，并得出以下预后指数（PI）：PI =（大小×0.0395）+（充血性胃病×0.878）+（胃静脉曲张×0.705）。该指数采用拆分样本技术进行验证，在预测出血方面似乎优于NIEC指数，可能有助于一级预防的决策制定。
