Risk Factors Of Hemorrhage In Pancreatic Portal Hypertension Complicated By Gastric Variceal Rupture

The purpose:Analyze the risk factors related to gastric varices bleeding in patients with pancreatic portal hypertension,and provide reference basis for clinical first-line physicians for the prevention and treatment of patients with pancreatic portal hypertension complicated with gastric varices bleeding.The method:1.A retrospective analysis of 164 patients with pancreatic portal hypertension(PPH)admitted to Hunan Provincial People’s Hospital from January 2011 to December 2019,in which 22 patients with bleeding from gastric varices were divided into the bleeding group and selected In the same period,142 patients without bleeding from gastric varices served as the control group;2.Collect and statistically analyze the basic information of 164 patients with PPH: gender,age,etiology,and laboratory test results:platelet count(PLT),prothrombin time(PT),fibrinogen(FIB),activated partial coagulation Proenzyme time(APTT),thrombin time(TT),blood glucose,imaging CT examination: spleen thickness,gastroepiploic vein diameter,left gastric vein internal diameter,gastroepiploic vein internal diameter/left gastric vein internal diameter,a total of 13 indicators.Firstly,single-factor statistical analysis and comparison of these clinical indicators are used to screen out the indicators with statistical differences,and to find out the risk factors of PPH complicated by gastric varices rupture and bleeding,and finally to perform statistical analysis of binary logistic regression on these indicators,to find out the independent risk factors for PPH complicated with gastric varices bleeding.The accuracy of model prediction is used to judge the quality of model fitting,the receiver operating characteristic curve(ROC curve)and nomogram are drawn based on independent risk factors,and the area under the ROC curve(AUC)of the prediction model is calculated.The result:A single factor statistical analysis of the clinical indicators of the bleeding group and the control group included in this study showed that the six indicators with significant statistical differences(P<0.05)were platelets(PLT),prothrombin time(PT),Fibrinogen(FIB),spleen thickness,left gastric vein internal diameter,gastro-omental vein internal diameter/gastric left gastric vein internal diameter,are risk factors for PPH complicated with gastric variceal bleeding.Then,the 6 indicators with significant statistical differences were analyzed by binary logistic regression,and the results showed that the left gastric vein inner diameter(P=0.000,OR:3.843,95% CI: 1.827-8.086),gastro-omentum The inner diameter of the vein/the inner diameter of the left gastric vein(P=0.034,OR: 0.021,95% CI: 0.001-0.751)was an independent risk factor for PPH complicated with gastric varices bleeding.The prediction model has high prediction accuracy and probability.Its overall prediction accuracy rate is93.87%,and the prediction probability(AUC)reaches 94.6%.The conclusion:1.PLT,PT,FIB,and spleen thickness are independent risk factors for PPH complicated with gastric varices bleeding;2.T The inner diameter of the left gastric vein is an independent risk factor for PPH complicated with gastric varices bleeding,and is positively correlated with it.The inner diameter of the gastro-omental vein/the left gastric vein is an independent risk factor for PPH complicated with gastric varices bleeding,and it is negatively correlated with it.3.Gastric omental vein compensation can reduce gastric venous pressure and reduce the risk of PPH complicated by gastric varices rupture and bleeding.It can provide us with some new treatment ideas in clinical practice.