经颈静脉肝内门体分流术治疗肝硬化伴食管胃静脉曲张破裂出血患者术后生存预测模型的建立和验证

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Abstract：ObjectiveToinvestigate theriskfactors forsurvival aftertransjugular intrahepaticportosystemicshunt（TPS）in patientswithlivercirrosisandesophagogastricvaricealbleeding（EGVB），andtoestablishapredictivemodelforsurvivalafter TIPS.MethodsClinicaldatawerecollctedfrom352patientswithlivercirhosisandEGVBwhounderwentTIPSinDepartment ofGastroenterologyAfiliatedDumTowerHospitalofNanjing UniversityMedicalSchool，fromJanuaryO15toDecember2018， and the patients were randomly divided into training group （ n=248 ）andvalidation group （ n=104 ）at a ratio of 7：3 . The Cox regresionanalysiswasusedtoidentifytheindependentriskfactorsforsurvivalafterTIPS，andanomogrampredictivemodelwas established.Theindexofconcordance（C-index）andthereceiveroperatingcharacteristic（ROC）curve wereusedtossesste discriminatoryabilityofthemodelandthecalibratiocurveasusedtossstepredictivevalueoftemodel.Teindepedent samples t testwasusedforcomparisonofnormallydistributedcontinuousdatabetween two groups，andtheWilcoxonrank-sumtestwas usedforcomparisonofnon-noalldisriutedcontiuousdatabetweetwgroups；thechisquaretestwasusedforcomparisonof categoricaldatabetweentwogroups.TeKaplan-Meieranalysiswasusedtocalculatecumulativesurvivalrate.ResultsFortepatints in the training group，the 1-，3-，and 5-year cumulative survival rates were 91.1 % 79.5% ，and 77.0% ，respectively. The multivariate Cox regression analysis showed that age （hazard ratio [HR]=1.047 ，95 % confidence interval ⌊CI⌋：1.032-1.092，P<0.001） ，MELD score （HR=1.127，95%CI： 1.003—1.268， P =0.045），and serum sodium（Na）（ HR =0.928， 95%CI： 0.878—0.981， P =0.008）were independentinfluencingfactorsforsurvival，andapredictivemodelandanomogramwereestablishedbasedonthesefactors.The predictivemodelhadaC-idexofO.76OinthetraininggroupandO.757inthevalidationgroup.Inthetraining groupthenomogamhad an area under the ROC curve of O.8O7，O.788，and O.787，respectively，in predicting 1-，3- ，and 5-year cumulative survival rates. The calibrationcureshowedrelativelyhighconsistencybetweetheresultspredictedbythenomogramandtheactualresultsConclusionA nomogrammodelisestablishedbasedonage，MELDscore，andNaforpredictingsurvivalafterTSinpatientswithliverciosisnd EGVB，and this model has good discriminatory ability and accuracy.

KeyWords：Liver Cirrosis；Esophagealand Gastric Varices；PortasystemicShunt，Transjugular Intraepatic；Prognosis; Nomograms

Research funding：National Natural ScienceFoundation ofChina（82370628）

门静脉高压症是肝硬化的主要并发症之一，包括腹水、肝性脑病（HE）和出血。（剩余11389字）