老年肝硬化门静脉高压并发上消化道出血的高危因素及预测模型建立

High risk factors for upper gastrointestinal bleeding in elderly patients with liver cirrhotic portal hypertension and establish-ment of a predictive model

中文关键词: 老年  肝硬化  门静脉高压  上消化道出血  高危因素  预测模型

英文关键词: elderly  liver cirrhosis  portal hypertension  upper gastrointestinal bleeding  high risk factor  predictive model

中文摘要:

      目的 分析老年肝硬化门静脉高压患者并发上消化道出血的高危因素,并建立预测模型.方法 回顾性选取2020年10月—2024年10月联勤保障部队第904医院和无锡市第五人民医院收治的269例老年肝硬化门静脉高压患者的临床资料,根据是否并发上消化道出血分为出血组(n=80)和未出血组(n=189).采用单因素和多因素Logistic回归方法分析影响老年肝硬化门静脉高压患者并发上消化道出血的高危因素,并建立风险预测模型,同时绘制受试者工作特征曲线(ROC)对预测模型的预测效能进行评估.结果 多因素Logistic回归分析结果显示,肝硬化病程＞3年、食管胃底静脉曲张、PT延长是影响老年肝硬化门静脉高压患者并发上消化道出血的高危因素(P＜0.05);建立老年肝硬化门静脉高压患者并发上消化道出血的预测模型,Hosmer-Lemeshow拟合度检验显示预测模型的拟合度良好(x2=11.107,P=0.196),预测模型的曲线下面积(AUC)为0.838,显示预测模型具有较好的预测效能.结论 老年肝硬化门静脉高压患者并发上消化道出血的发生可能与肝硬化病程、食管胃底静脉曲张及PT有关,根据高危因素建立预测模型,可较好地预测老年肝硬化门静脉高压患者并发上消化道出血的发生风险.

英文摘要:

      Objective To analyze the high risk factors for upper gastrointestinal bleeding in elderly patients with liver cirrhotic portal hypertension,and establish a prediction model.Methods The clinical data of 269 elderly patients with cirrhot-ic portal hypertension admitted to Hospital 904 of Joint Logistic Support Force and Fifth People's Hospital of Wuxi City from October 2020 to October 2024 were retrospectively selected.They were divided into bleeding group(n=80)and non-bleeding group(n=189)according to whether they had concurrent upper gastrointestinal bleeding.Univariate and multivariate Logistic regression methods were used to analyze the high-risk factors for upper gastrointestinal bleeding in elderly patients with liver cir-rhotic portal hypertension,and a risk prediction model was established.The receiver operating characteristic curve(ROC)was drawn to evaluate the predictive efficacy of the prediction model.Results The results of multivariate Logistic regression analy-sis showed that the course of liver cirrhosis＞3 years,esophageal and gastric varices,and prolonged PT were high risk factors for upper gastrointestinal bleeding in elderly patients with cirrhotic portal hypertension(P＜0.05).A predictive model for up-per gastrointestinal bleeding in elderly patients with cirrhotic portal hypertension was established.The Hosmer-Lemeshow fit test showed that the fit of the prediction model was good(x2=11.107,P=0.196),and the area under the curve(AUC)of the prediction model was 0.838,indicating that the prediction model had good prediction performance.Conclusion The occur-rence of upper gastrointestinal bleeding in elderly patients with cirrhotic portal hypertension may be related to the course of liver cirrhosis,esophageal and gastric varices and prolonged PT.The predictive model established based on these high-risk factors can well predict the risk of upper gastrointestinal bleeding in elderly patients with cirrhotic portal hypertension.