南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (12): 1822-1827.doi: 10.12122/j.issn.1673-4254.2021.12.10

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紫色征对肝硬化静脉曲张破裂出血患者内镜治疗后再出血风险的预测作用

吴 苑，陈明榆，黄梦芬，廖桂彬，唐舒婷，郑鸿铭，李逸婷，彭 彬，郑小妹，潘思敏，侯江涛，陈 斌   

  1. 广州中医药大学第一临床医学院，广州中医药大学第一附属医院脾胃病科，广东 广州 510000
  • 出版日期:2021-12-20 发布日期:2022-01-05

Value of purple sign for predicting rebleeding events in cirrhotic patients following endoscopic selective varices devascularization

WU Yuan, CHEN Mingyu, HUANG Mengfen, LIAO Guibin, TANG Shuting, ZHENG Hongming, LI Yiting, PENG Bin, ZHENG Xiaomei, PAN Simin, HOU Jiangtao, CHEN Bin   

  1. First Clinical Medical College, Department of Gastroenterology and Hepatology of First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
  • Online:2021-12-20 Published:2022-01-05

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摘要： 目的 研究紫色征对肝硬化静脉曲张破裂出血内镜治疗后再出血的预测作用。方法 研究对97例肝硬化静脉曲张破裂出血患者行内镜下精准贲门胃静脉曲张断流术（ESVD术）治疗进行回顾性分析，根据内镜治疗过程中是否出现了紫色征进行分组，出现紫色征患者为观察组，共32例，未出现紫色征患者为对照组，共65例；通过倾向性匹配评分的方式平衡观察组（紫色征组）与对照组（非紫色征组）患者临床特征的差异，同时减少研究对象的选择偏倚，研究结局为ESVD术后再出血率。结果 匹配前观察组与对照组1年再出血率（27.0% vs 36.7%）与6月再出血率（10.9% vs 26.9%）差异无统计学差异（P=0.2385）；匹配后观察组与对照组1年再出血率（28.2% vs 56.4%）与6月再出血率（5.0% vs 37.0%）差异有统计学意义（P=0.0304）。结论 紫色征可作为预测肝硬化患者胃食管静脉曲张破裂出血后低再出血风险的指标，为此类患者内镜序贯治疗管理提供指导意义。

关键词: 紫色征；再出血；内镜下精准贲门胃静脉曲张断流术；食管胃底静脉曲张；倾向性匹配评分

Abstract: Objective To assess the value of the purple sign for predicting long-term rebleeding events in cirrhotic patients following endoscopic selective varices devascularization. Methods 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. Results The 1-year rebleeding rate (27.0% vs 36.7%) or 6-month rebleeding rate (10.9% vs 26.9%) following endoscopic treatment was not significantly different between the purple sign group and no purple sign group before PSM (P=0.2385). But after PSM, the 1-year rebleeding rate (28.2% vs 56.4% ) and 6-month rebleeding rate (5.0% vs 37.0% ) were significantly lower in the purple sign group than in the no purple sign group (P=0.0304). Conclusions 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.

Key words: purple sign; rebleeding; endoscopic selective varices devascularization; gastroesophageal varices; propensity score matching