基于CT静脉造影的肝硬化胃静脉曲张内镜治疗后再出血危险因素分析

Risk Factors for Rebleeding after Endoscopic Cyanoacrylate Injection in Cirrhotic Patients with Gastric Varices: A Computed Tomographic Venography-Based Analysis

摘要: 目的：基于CT静脉造影(Computed Tomographic Venography, CTV)分析肝硬化胃静脉曲张(Gastric Varices, GV)患者内镜组织胶注射术(Endoscopic Cyanoacrylate Injection, ECI)后不同时段再出血的独立危险因素。方法：回顾性纳入2020年1月1日~2024年12月31日于烟台毓璜顶医院接受CTV-ECI的222例肝硬化GV出血患者，按术后出血时间分为未再出血组(137例)、3 d内组(12例)、早期组(3 d~6周，30例)及晚期组(>6周，43例)。收集实验室与CTV定量指标，通过多分类Logistic回归筛选各时段的独立影响因素。结果：① 总再出血率38.2% (85/222)。门静脉内径增宽为各时段共同的危险因素，白蛋白升高为共同的保护因素。② 3 d内再出血：血小板升高为保护因素；早期再出血：合并红色征风险增加；晚期再出血：总胆红素升高、门静脉血栓及异位分流为独立危险因素。结论：基于CTV联合实验室指标，本研究明确了肝硬化GV患者ECI术后不同时段再出血的独立危险因素谱，其具有明显的时间异质性，为实施时段特异性的风险监测与精准干预提供了依据。

Abstract: Objective: To identify independent risk factors for time-specific rebleeding after endoscopic cyanoacrylate injection (ECI) in cirrhotic patients with gastric varices (GV) using pre-operative computed tomographic venography (CTV). Methods: We retrospectively enrolled 222 consecutive cirrhotic patients with gastric variceal bleeding who underwent computed tomographic venography-guided endoscopic cyanoacrylate injection (CTV-ECI) at Yantai Yuhuangding Hospital between January 1, 2020 and December 31, 2024. Patients were categorized according to time to post-procedural rebleeding as follows: no rebleeding (n = 137), ≤3 days (n = 12), early rebleeding (3 days~6 weeks, n = 30), and late rebleeding (>6 weeks, n = 43). Laboratory variables and CTV quantitative parameters were collected. Multinomial logistic regression analysis was performed to identify independent predictors for each time interval. Results: Overall rebleeding rate was 38.2% (85/222). Wider portal vein diameter was a shared risk factor across all intervals, whereas higher serum albumin was a consistent protective factor. For rebleeding ≤ 3 days, higher platelet count was protective. For early rebleeding (3 days~6 weeks), the presence of red-color sign increased the risk. For late rebleeding (>6 weeks), elevated total bilirubin, portal vein thrombosis, and ectopic shunts were independent risk factors. Conclusion: This study delineates a distinct, time-dependent risk profile for rebleeding after ECI in cirrhotic GV patients using CTV and laboratory parameters, providing a foundation for interval-specific surveillance and tailored intervention.