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肝硬化食管胃静脉曲张破裂出血伴心肌损伤的危险因素分析
Risk factors for myocardial injury in esophagogastric variceal bleeding patients with cirrhosis
- 陆军军医大学学报 2024年46卷第3期 页码：271-276
- 作者机构：
430060 武汉，武汉大学人民医院消化内科
- 作者简介：
[ 陈明锴，E-mail：kaimingchen@163.com CHEN Mingkai, E-mail: kaimingchen@163.com
- 基金信息：湖北省重点研发计划项目(2020BCB007)
DOI：10.16016/j.2097-0927.202303170
中图分类号： R542.2;R571.3;R575.2收稿：2023-03-25，
修回：2023-07-15，
纸质出版：2024-02-15
- 稿件说明：
移动端阅览
柯舸, 肖勇, 张弛, 等. 肝硬化食管胃静脉曲张破裂出血伴心肌损伤的危险因素分析[J]. 陆军军医大学学报, 2024,46(3):271-276.
Ge KE, Yong XIAO, Chi ZHANG, et al. Risk factors for myocardial injury in esophagogastric variceal bleeding patients with cirrhosis[J]. Journal of Army Medical University, 2024, 46(3): 271-276.
柯舸, 肖勇, 张弛, 等. 肝硬化食管胃静脉曲张破裂出血伴心肌损伤的危险因素分析[J]. 陆军军医大学学报, 2024,46(3):271-276. DOI： 10.16016/j.2097-0927.202303170.
Ge KE, Yong XIAO, Chi ZHANG, et al. Risk factors for myocardial injury in esophagogastric variceal bleeding patients with cirrhosis[J]. Journal of Army Medical University, 2024, 46(3): 271-276. DOI： 10.16016/j.2097-0927.202303170.
摘要
目的
2
探讨肝硬化食管胃底静脉曲张破裂出血(esophagogastric variceal bleeding，EGVB)患者院内并发心肌损伤的危险因素。
方法
2
本研究采用病例-对照研究设计方案。收集2021年5月至2022年7月期间武汉大学人民医院收治的235例EGVB患者的基本信息、实验室检查以及住院期间的相关资料。根据患者住院期间的心肌酶谱将其分为心肌损伤组(46例)及非心肌损伤组(189例)，通过单因素回归分析及临床相关性初筛肝硬化EGVB继发心肌损伤的危险因素，通过多因素Logistic回归分析进一步筛选危险因素，对筛选出的危险因素使用列线图体现其与心肌损伤发生的关联，采用受试者工作曲线(ROC)评价各因素的独立预测价值以及联合预测价值，做出模型的校准度曲线。使用留一法进行内部验证；进一步对心肌梗死组进行亚组验证。
结果
2
单因素分析发现，年龄、性别、高血压、肾病、基础疾病史、呕血、白细胞水平升高、丙氨酸氨基转移酶(ALT)或天冬氨酸转氨酶(AST)上升、白蛋白(ALB)、红细胞比容(HCT)、国际标准比率(INR)、内镜时间6 h内、Child-Pugh分级(CP分级)在心肌损伤组与非心肌损伤组间差异有统计学意义(
P
＜0.1)。多因素Logistic回归分析发现，年龄(
P
=0.014，
OR
=1.153，95%
CI
：1.030~1.291)、基础疾病史(
P
=0.005，
OR
=1.122，95%
CI
：1.032~2.437)、ALB(
P
=0.012，
OR
=0.449，95%
CI
：0.241~0.837)均是肝硬化EGVB患者院内并发心肌损伤的独立危险因素，三者联合诊断模型的ROC曲线下面积AUC=0.902。模型校准度Hosmer-Lemeshow检验：χ
2
=12.88，
P
=0.615，具有良好的拟合优度。内部验证正确区分了86.4%的验证对象。对心肌梗死患者的亚组分析发现，ALB是该类患者院内并发心肌梗死的独立危险因素(AUC=0.80)。
结论
2
年龄、基础疾病史、ALB水平是EGVB患者院内并发心肌损伤的独立危险因素；ALB可作为预测心肌梗死的独立危险因素，三者联合具有较高的早期识别该类患者并防治其心肌损伤的临床价值。
Abstract
Objective
2
To explore the risk factors for myocardial injury in esophagogastric variceal bleeding (EGVB) patients with liver cirrhosis during hospitalization.
Methods
2
A case-control trial was conducted on 235 EGVB patients admitted to our hospital between May 2021 and July 2022. Their basic information
laboratory results and relevant data during hospitalization were collected. According to their myocardial enzyme profiles during hospitalization
they were divided into myocardial injury group (
n
=46) and non-myocardial injury group (
n
=189). Univariate regression analysis and clinical correlation analysis were used to preliminarily screen the risk factors for myocardial injury secondary to EGVB caused by liver cirrhosis. Then
multivariate logistic regression analysis was used to further screen the risk factors. A nomogram was constructed based on the selected risk factors and the occurrence of myocardial injury. Receiver operating characteristic (ROC) curve was plotted to analyze the independent predictive value of these factors alone or combined together. Calibration curve analysis and internal verification were utilized to evaluate the predictive performance of the nomogram model. Subgroup verification was performed in the myocardial infarction group.
Results
2
Univariate analysis revealed that statistical differences were observed in age
sex
hypertension
renal disease
underlying diseases
vomiting
leukocytosis
increased alanine aminotransferase (ALT) or aspartate aminotransferase (AST)
albumin
red blood cell hematocrit (HCT)
international normalized ratio (INR)
endoscopy within 6 h after admission
and Child-Pugh (CP) class between the myocardial injury group and the non-myocardial injury group (
P
<
0.01). Multivariate logistic regression analysis showed that age (
P
=0.014
OR
=1.153
95%
CI
: 1.030~1.291)
underlying diseases (
P
=0.005
OR
=1.122
95%
CI
: 1.032~2.437)
and albumin (
P
=0.012
OR
=0.449
95%
CI
: 0.241~0.83
7) were independent risk factors for inhospital myocardial injury in EGVB patients with liver cirrhosis. The AUC value of the above indicators combined together for predicting myocardial injury was 0.902. Hosmer-Lemeshow test and calibration curve analysis indicated that the nomogram had good prediction consistency (
Chi
-square=12.88
P
=0.615). Internal verification correctly distinguished 86.4% of verification objects. Subgroup analysis of myocardial injury patients showed that albumin was also an independent risk factor for in-hospital myocardial injury in this population (AUC=0.80).
Conclusion
2
Age
underlying diseases
and albumin level are independent risk factors for in-hospital myocardial injury in EGVB patients with liver cirrhosis. Albumin level can be used as an independent risk factor for predicting myocardial infarction. Combination of the above 3 indicators has a high diagnostic value in early identification and prevention of myocardial injury in this patient population.
关键词
Keywords
references
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