Page 90 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第44卷第2期
·228 · Journal of Nanjing Medical University（Natural Sciences） 2024年2月

·临床研究·

食管曲张静脉最大直径对肝硬化患者首次食管曲张静脉出血

风险的预测价值

谢玉官 ，吴军政 ，杨 魏 ，周海峰 ，刘 圣 ，施海彬 ，周卫忠 1*
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南京医科大学第一附属医院介入放射科，江苏 南京 210029；南京鼓楼医院介入影像科，江苏 南京 210008
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［摘 要］ 目的：预测伴有食管静脉曲张的肝硬化患者发生首次曲张静脉出血的风险。方法：回顾性分析2016年1月—2019年
3月在南京医科大学第一附属医院确诊为肝硬化伴食管静脉曲张患者的临床资料。利用单因素及多因素Cox回归分析确定肝
硬化食管静脉曲张患者出现首次曲张静脉出血的独立预后因素。使用R软件构建列线图模型，采用受试者工作特征（ROC）曲
线评估列线图模型的预测能力。采用Bootstrap 法进行模型内验证，计算一致性指数（C⁃index）评价模型的区分度。绘制校准
曲线以评估模型的校准度。结果：食管曲张静脉最大直径、脾脏上下径、总胆红素是肝硬化食管静脉曲张患者出现首次曲张静
脉出血的独立危险因素。基于此构建列线图预测模型，该模型的1年内无首次出血的ROC曲线下面积（AUC）为0.918，2年内
无首次出血的AUC为0.893。经内部验证后，模型的C⁃index为0.852。校准曲线表明该列线图预测结果与实际结果具有良好
的一致性。结论：食管曲张静脉最大直径、总胆红素对肝硬化食管静脉曲张患者出现首次曲张静脉出血具有良好预测作用。
基于食管曲张静脉最大直径、脾脏上下径、总胆红素3项指标建立的列线图预测模型具有良好的区分度与准确度。
［关键词］ 肝硬化；食管静脉曲张；曲张静脉出血；列线图
［中图分类号］ R575.2 ［文献标志码］ A ［文章编号］ 1007⁃4368（2024）02⁃228⁃07
doi：10.7655/NYDXBNSN230744

The predictive value of the maximum diameter of esophageal varices for the risk of initial
esophageal variceal bleeding in patients with liver cirrhosis
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XIE Yuguan ，WU Junzheng ，YANG Wei ，ZHOU Haifeng ，LIU Sheng ，SHI Haibin ，ZHOU Weizhong 1*
1 Department of Interventional Radiology，the First Affiliated Hospital of Nanjing Medical University，Nanjing
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210029；Department of Interventional Radiology，Nanjing Drum Tower hospital，Nanjing 210008，China
［Abstract］ Objective：To predict the risk of initial esophageal variceal bleeding in patients with liver cirrhosis accompanied by
esophageal varices. Methods：Clinical data of patients diagnosed with liver cirrhosis accompanied by esophageal varices at the First
Affiliated Hospital of Nanjing Medical University from January 2016 to March 2019 were retrospectively analyzed. Univariate and
multivariate Cox regression analyses were used to determine the independent prognostic factors for the occurrence of initial esophageal
variceal bleeding in patients with liver cirrhosis and esophageal varices. R software was used to construct the nomogram model.
Receiver operating characteristic（ROC）curve was used to assess the prediction ability of the nomogram model. Bootstrap method was
used for in⁃model validation and concordance index（C⁃index）was calculated to evaluate the discrimination of the model. Calibration
curve was plotted to assess the calibration of the model. Results：The maximum diameter of esophageal varices，spleen longitudinal
diameter，and total bilirubin（TBIL）were independent risk factors for the occurrence of initial esophageal variceal bleeding in patients
with liver cirrhosis and esophageal varices. Based on this，a nomogram prediction model was constructed，with an area under the ROC
curve（AUC）of 0.918 for no initial bleeding within 1 year and an AUC of 0.893 for no initial bleeding within 2 years. After internal
verification，the C ⁃ index of the model was 0.852. The calibration curve shows good consistency between the nomogram prediction
results and actual results. Conclusion：The maximum diameter of esophageal varices and TBIL have good predictive value of the
occurrence of initial variceal bleeding in patients with liver cirrhosis and esophageal varices. The prediction model based on the three

［基金项目］ 江苏省科教能力提升工程（JSDW202243）
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通信作者（Corresponding author），E⁃mail：xmjbq007@163.com