肝硬化食管胃底静脉曲张出血无创性预测方法的研究进展
Research Progress on Non-Invasive Prediction Methods for Esophageal and Gastric Variceal Bleeding in Cirrhosis
DOI: 10.12677/acm.2026.1641577, PDF,   
作者: 姜晗宇, 姚佳奇, 樊佳鑫, 逯弈彤：北华大学临床医学院，吉林 吉林；黄维莉*：北华大学附属医院消化内科，吉林 吉林
关键词: 肝硬化；食管胃底静脉曲张出血；血栓弹力图；ALBI评分；PALBI评分；Liver Cirrhosis； Esophagogastric Variceal Bleeding； Thromboelastography； ALBI Score； PALBI Score
摘要: 肝硬化是一种慢性、进行性、弥漫性的肝脏疾病。其特点是肝细胞广泛坏死、纤维组织增生、假小叶形成，最终导致肝脏质地变硬、体积缩小、功能丧失，并引发一系列严重并发症。其中，食管胃底静脉曲张破裂出血(esophagogastric variceal bleeding, EGVB)是肝硬化最危急、最致命的并发症。近年来，大量研究期望以无创性研究方法来诊断食管胃底静脉曲张，替代胃镜检查成为该疾病早期筛查、后期随访的重要手段。本文主要阐述血栓弹力图及PALBI评分在EGVB中的作用及机制进行综述，旨在为临床治疗和预后提供新的靶点。
Abstract: Liver cirrhosis is a chronic, progressive, and diffuse liver disease characterized by extensive hepatocellular necrosis, fibrous tissue proliferation, and the formation of pseudolobules, ultimately leading to hepatic hardening, volume reduction, functional loss, and a series of severe complications. Among these, esophagogastric variceal bleeding (EGVB) is the most critical and life-threatening complication of cirrhosis. In recent years, numerous studies have focused on non-invasive diagnostic methods for esophageal and gastric varices, aiming to replace gastroscopy as a crucial tool for early screening and subsequent follow-up of this condition. This article reviews the role and mechanisms of thromboelastography and the PALBI score in EGVB, with the goal of providing new targets for clinical treatment and prognosis.
文章引用：姜晗宇, 黄维莉, 姚佳奇, 樊佳鑫, 逯弈彤. 肝硬化食管胃底静脉曲张出血无创性预测方法的研究进展[J]. 临床医学进展, 2026, 16(4): 3180-3185. https://doi.org/10.12677/acm.2026.1641577

参考文献

[1] Asrani, S.K., Devarbhavi, H., Eaton, J. and Kamath, P.S. (2019) Burden of Liver Diseases in the World. Journal of Hepatology, 70, 151-171. [Google Scholar] [CrossRef] [PubMed]
[2] Lesmana, C.R.A., Raharjo, M. and Gani, R.A. (2020) Managing Liver Cirrhotic Complications: Overview of Esophageal and Gastric Varices. Clinical and Molecular Hepatology, 26, 444-460. [Google Scholar] [CrossRef] [PubMed]
[3] Jakab, S.S. and Garcia-Tsao, G. (2020) Evaluation and Management of Esophageal and Gastric Varices in Patients with Cirrhosis. Clinics in Liver Disease, 24, 335-350. [Google Scholar] [CrossRef] [PubMed]
[4] Zanetto, A., Barbiero, G., Battistel, M., Sciarrone, S.S., Shalaby, S., Pellone, M., et al. (2021) Management of Portal Hypertension Severe Complications. Minerva Gastroenterology, 67, 26-37. [Google Scholar] [CrossRef] [PubMed]
[5] Elshaarawy, O., Allam, N., Abdelsameea, E., Gomaa, A. and Waked, I. (2020) Platelet-Albumin-Bilirubin Score—A Predictor of Outcome of Acute Variceal Bleeding in Patients with Cirrhosis. World Journal of Hepatology, 12, 99-107. [Google Scholar] [CrossRef] [PubMed]
[6] 王俊超, 汤书豪, 方心怡, 等. 血栓弹力图在肝硬化患者中的应用研究进展[J]. 现代消化及介入治疗, 2024, 29(10): 1236-1240.
[7] 夏丽波, 简翠, 张碧玉, 等. 儿童血栓弹力图参考区间建立及与常规凝血项目的比较[J]. 检验医学, 2017, 32(2): 81-85.
[8] Bonnet, N., Paul, J., Helleputte, T., Veyckemans, F., Pirotte, T., Prégardien, C., et al. (2019) Novel Insights into the Assessment of Risk of Upper Gastrointestinal Bleeding in Decompensated Cirrhotic Children. Pediatric Transplantation, 23, e13390. [Google Scholar] [CrossRef] [PubMed]
[9] Kumar, M., Ahmad, J., Maiwall, R., Choudhury, A., Bajpai, M., Mitra, L.G., et al. (2020) Thromboelastography‐Guided Blood Component Use in Patients with Cirrhosis with Nonvariceal Bleeding: A Randomized Controlled Trial. Hepatology, 71, 235-246. [Google Scholar] [CrossRef] [PubMed]
[10] Kohli, R., Shingina, A., New, S., Chaturvedi, S., Benson, A., Biggins, S.W., et al. (2019) Thromboelastography Parameters Are Associated with Cirrhosis Severity. Digestive Diseases and Sciences, 64, 2661-2670. [Google Scholar] [CrossRef] [PubMed]
[11] Zanetto, A., Rinder, H.M., Senzolo, M., Simioni, P. and Garcia-Tsao, G. (2021) Reduced Clot Stability by Thromboelastography as a Potential Indicator of Procedure-Related Bleeding in Decompensated Cirrhosis. Hepatology Communications, 5, 272-282. [Google Scholar] [CrossRef] [PubMed]
[12] Hum, J., Amador, D., Shatzel, J.J., Naugler, W.E., Ahn, J., Zaman, A., et al. (2020) Thromboelastography Better Reflects Hemostatic Abnormalities in Cirrhotics Compared with the International Normalized Ratio. Journal of Clinical Gastroenterology, 54, 741-746. [Google Scholar] [CrossRef] [PubMed]
[13] 孙梦秋, 张爱霞, 张莉, 等. 血栓弹力图参数评估乙型肝炎肝硬化合并食管胃底静脉曲张破裂出血的意义[J]. 肝脏, 2024, 29(9): 1091-1095.
[14] 张雪, 虞雪融, 黄宇光. 血栓弹力图的临床应用[J]. 协和医学杂志, 2016, 7(4): 303-305.
[15] Johnson, P.J., Berhane, S., Kagebayashi, C., Satomura, S., Teng, M., Reeves, H.L., et al. (2015) Assessment of Liver Function in Patients with Hepatocellular Carcinoma: A New Evidence-Based Approach—The ALBI Grade. Journal of Clinical Oncology, 33, 550-558. [Google Scholar] [CrossRef] [PubMed]
[16] 范依静, 楼晓军, 吴雨林. 白蛋白-胆红素评分在肝硬化中的研究进展[J]. 中国现代医生, 2023, 61(7): 112-116.
[17] Wang, J., Zhang, Z., Yan, X., Li, M., Xia, J., Liu, Y., et al. (2019) Albumin-Bilirubin (ALBI) as an Accurate and Simple Prognostic Score for Chronic Hepatitis B-Related Liver Cirrhosis. Digestive and Liver Disease, 51, 1172-1178. [Google Scholar] [CrossRef] [PubMed]
[18] Miyaaki, H., Ichikawa, T., Taura, N., et al. (2014) Endoscopic Management of Esophagogastric Varices in Japan. Annals of Translational Medicine, 2, 42.
[19] Villanueva, C., Piqueras, M., Aracil, C., Gómez, C., López-Balaguer, J.M., Gonzalez, B., et al. (2006) A Randomized Controlled Trial Comparing Ligation and Sclerotherapy as Emergency Endoscopic Treatment Added to Somatostatin in Acute Variceal Bleeding. Journal of Hepatology, 45, 560-567. [Google Scholar] [CrossRef] [PubMed]
[20] Wang, Z., Xie, Y., Lu, Q., Yan, H., Liu, X., Long, Y., et al. (2020) The Impact of Albumin Infusion on the Risk of Rebleeding and In-Hospital Mortality in Cirrhotic Patients Admitted for Acute Gastrointestinal Bleeding: A Retrospective Study of a Single Institute. BMC Gastroenterology, 20, Article No. 198. [Google Scholar] [CrossRef] [PubMed]
[21] de Franchis, R., Abraldes, J.G., Bajaj, J., et al. (2015) Expanding Consensus in Portal Hypertension: Report of the Baveno VI Consensus Workshop: Stratifying Risk and Individualizing Care for Portal Hypertension. Journal of Hepatology, 63, 743-752. [Google Scholar] [CrossRef] [PubMed]
[22] 徐小元, 丁惠国, 李文刚, 等. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425.
[23] Hu, T., Stock, S., Hong, W. and Chen, Y. (2020) Modified ‘sandwich’ Injection with or without Ligation for Variceal Bleeding in Patients with Both Esophageal and Gastric Varices: A Retrospective Cohort Study. Scandinavian Journal of Gastroenterology, 55, 1219-1224. [Google Scholar] [CrossRef] [PubMed]
[24] 李德钊, 李健, 郭晓林. 白蛋白-胆红素评分对肝硬化食管胃静脉曲张出血患者预后的预测价值[J]. 临床肝胆病杂志, 2021, 37(5): 1085-1090.
[25] 戴天骄, 李静. 血小板-白蛋白-胆红素指数(PALBI)联合AIMS65评分对肝硬化并发急性上消化道出血患者短期预后的预测价值[J]. 临床肝胆病杂志, 2024, 40(2): 298-305.
[26] Liu, Y., Wu, S., Cai, S. and Xie, B. (2024) The Prognostic Evaluation of ALBI Score in Endoscopic Treatment of Esophagogastric Varices Hemorrhage in Liver Cirrhosis. Scientific Reports, 14, Article No. 780. [Google Scholar] [CrossRef] [PubMed]
[27] Roayaie, S., Jibara, G., Berhane, S., et al. (2015) Palbi-An Objective Score Based on Platelets, Albumin & Bilirubin Stratifies Hcc Patients Undergoing Resection & Ablation Better than Child’s Classification: 851. Hepatology, 62, 631A-632A.
[28] Chatterjee, M. and Geisler, T. (2016) Inflammatory Contribution of Platelets Revisited: New Players in the Arena of Inflammation. Seminars in Thrombosis and Hemostasis, 42, 205-214. [Google Scholar] [CrossRef] [PubMed]
[29] Simon, T.G., Henson, J., Osganian, S., Masia, R., Chan, A.T., Chung, R.T., et al. (2020) Daily Aspirin Use Associated with Reduced Risk for Fibrosis Progression in Patients with Nonalcoholic Fatty Liver Disease. Clinical Gastroenterology and Hepatology, 17, 2776-2784.e4. [Google Scholar] [CrossRef] [PubMed]
[30] Hofer, B.S., Brusilovskaya, K., Simbrunner, B., Balcar, L., Eichelberger, B., Lee, S., et al. (2024) Decreased Platelet Activation Predicts Hepatic Decompensation and Mortality in Patients with Cirrhosis. Hepatology, 80, 1120-1133. [Google Scholar] [CrossRef] [PubMed]
[31] Zanetto, A., Campello, E., Senzolo, M. and Simioni, P. (2024) The Evolving Knowledge on Primary Hemostasis in Patients with Cirrhosis: A Comprehensive Review. Hepatology, 79, 460-481. [Google Scholar] [CrossRef] [PubMed]
[32] Brusilovskaya, K., Hofer, B.S., Simbrunner, B., Eichelberger, B., Lee, S., Bauer, D.J.M., et al. (2023) Platelet Function Decreases with Increasing Severity of Liver Cirrhosis and Portal Hypertension—A Prospective Study. Thrombosis and Haemostasis, 123, 1140-1150. [Google Scholar] [CrossRef] [PubMed]
[33] Alvaro, D., Caporaso, N., Giannini, E.G., Iacobellis, A., Morelli, M., Toniutto, P., et al. (2021) Procedure‐Related Bleeding Risk in Patients with Cirrhosis and Severe Thrombocytopenia. European Journal of Clinical Investigation, 51, e13508. [Google Scholar] [CrossRef] [PubMed]
[34] Gulzar, G.M., Zargar, S.A., Jalal, S., Alaie, M.S., Javid, G., Suri, P.K., et al. (2009) Correlation of Hepatic Venous Pressure Gradient with Variceal Bleeding, Size of Esophageal Varices, Etiology, Ascites and Degree of Liver Dysfunction in Cirrhosis of Liver. Indian Journal of Gastroenterology, 28, 59-61. [Google Scholar] [CrossRef] [PubMed]

为你推荐