HBV-DNA定量、肝脏硬度值与乙肝肝硬化并食管胃静脉曲张出血内镜治疗后早期再出血的相关性研究

目的 通过检测乙肝肝硬化并食管胃静脉曲张出血(EVB)经内镜治疗后患者的HBV-DNA定量、肝脏硬度值,探讨该两项指标对EVB内镜治疗后早期再出血的临床应用价值。方法 选取2016年8月—2018年7月行内镜治疗的EVB患者,根据治疗后是否发生早期出血分为出血组(27例)、未出血组(201例),记录两组患者HBV-DNA定量、肝脏硬度值并比较。对可能导致EVB术后再出血的风险因素进行赋值,然后行Logstic回归分析,对EVB术后再出血的风险因素进行初步探讨。通过描绘受试者工作曲线(ROC)观察HBV-DNA定量、肝脏硬度值与预测内镜治疗后再出血的相关性,并对上述指标联合检测的特异性、敏感度进行计算,观察上述指标联合检测的价值。结果 (1)本次研究的228例EVB患者中,有27例术后出现了早期再出血现象,EVB内镜治疗后早期再出血率为11.84%。(2)早期再出血患者HBV-DNA含量、肝脏硬度值显著高于未出血患者,两组比较有统计学意义(P＜0.01)。(3)Logistic回归分析显示:HBV-DNA、肝脏硬度值、空腹血糖、曲张静脉数量是EVB术后早期再出血的风险因子。(4)通过描绘ROC曲线发现,HBV-DNA含量、肝脏硬度值联合检测能显著提高预测EVB术后再出血的敏感度、特异性。结论 HBV-DNA定量、肝脏硬度值在EVB术后再出血患者中明显升高,是早期再出血的影响因子,临床上可通过HBV-DNA定量、肝脏硬度值检测评估EVB术后再出血风险。

Clinical study of the correlation between HBV-DNA quantification,liver hardness value and hepatitis B cirrhosis with esophageal and gastric varicose endoscopy for early rebleeding

Objective To investigate the clinical value of HBV-DNA quantification and liver stiffness in patients with hepatitis B cirrhosis complicated with esophagogastric variceal bleeding (EVB) after endoscopic treatment.Methods Patients with EVB who underwent endoscopic treatment from August 2016 to July 2018 were divided into the bleeding group (27 cases) and the non-bleeding group (201 cases) according to whether early bleeding occurred after treatment.The risk factors that may lead to rebleeding after EVB were assigned,and then Logstic regression analysis was performed to explore the risk factors of rebleeding after EVB.The correlation between HBV-DNA quantification,liver stiffness and prediction of rebleeding after endoscopic therapy was observed by describing the subject work curve (ROC). The specificity and sensitivity of the combined detection were calculated and the value of the combined detection was observed.Results (1)Among 228 EVB patients in this study,27 cases had early rebleeding after EVB.The early rebleeding rate after EVB endoscopy was 11.84%.(2)The HBV-DNA content and liver stiffness of patients with early rebleeding were significantly higher than those of patients without bleeding (P＜0.01).(3) Logistic regression analysis showed that HBV-DNA, liver stiffness,fasting blood glucose and the number of varices were risk factors for early rebleeding after EVB.(4)ROC curve showed that HBV-DNA content and liver stiffness could significantly improve the sensitivity and specificity of predicting rebleeding after EVB.Conclusion HBV DNA quantification and liver stiffness were significantly increased in patients with rebleeding after EVB.HBV DNA quantification and liver stiffness could be used to evaluate the risk of rebleeding after EVB.