Risk Factors Of Rebleeding Within 1 Year After First Endoscopic Treatment Of Esophageal And Gastric Variceal Bleeding

Objective: To explore the related risk factors of rebleeding within 1 year after endoscopic treatment in patients with ruptured esophageal and gastric varices liver cirrhosis,and to provide theoretical basis for clinical formulation of better prevention of rebleeding(secondary prevention)strategy.Methods: 1.Retrospective continuous collection between January 2015-January 2019,a department of digestive department of Shaanxi Provincial People's Hospital admitted patients with ruptured esophageal and gastric varices.81 patients treated with drugs only and 178 patients treated with first endoscopy were selected.The rebleeding rates of the two groups were compared according to whether the rebleeding occurred within one year or not.2.SPSS25.0 software was used to analyze the etiology,sex,age,smoking history and drinking history of liver cirrhosis,portal vein thrombosis and splenic-renal shunt,history of bleeding,splenomegaly,liver function Child-Pugh grade,laboratory examination,endoscopic LDRf typing,non-selective beta blocker and number of endoscopic treatments.The above factors were analyzed by single factor,P<0.05 indicated that the difference was statistically significant.Statistical analysis of meaningful indicators into the multi-factor model,rebleeding as a dependent variable,binary logistic regression analysis,the establishment of a regression model.Draw ROC curve to evaluate the prediction model.Results: 1.Rebleeding occurred in 95(53.37%)of 178 patients with rupture of the gastric varices of the hepatic sclerosing cannula complicated by the first endoscopic treatment.The results of univariate analysis showed age(P=0.025),NBSS(P=0.025),previous bleeding(P<0.001),number of endoscopic treatments(P<0.001),esophageal varices diameter(P<0.001),RF(P<0.001),liver function Child-Pugh score(P=0.041),alanine aminotransferase(0.036),alanine aminotransferase(P=0.031),international standardized ratio(0.10).049)is a related risk factor for rebleeding within 1 year after endoscopic treatment of esophageal and gastric varices.The results of multivariate non-conditional Logistic regression analysis showed that age,previous history of bleeding,diameter of esophageal varices,ALT were independent risk factors,and the number of endoscopic treatments was protective factors.the area(AUC)below the curve for the joint prediction of meaningful indicators in the multivariate analysis of the above indexes was 0.841,the sensitivity was 80%,and the specificity was 75.9%,which has certain accuracy in judging whether or not to bleed again.2.Among hepatitis b patients receiving antiviral therapy,the rebleeding rates were 35.29% and 67.50%(P<0.05)in the antiviral and non-antiviral groups,respectively.3.Average number of endoscopic treatment in the rebleeding group was less than that in the group without rebleeding(mean 1.43 and 1.92,respectively).the number of endoscopic treatment and whether rebleeding were performed a linear trend chi-square test(P<0.001).as the number of endoscopic treatment increased,the rebleeding rate gradually decreased.4.A chi-square test-only treatment groups,the rebleeding rate was analyzed by chi-square test(P=0.006),and the rebleeding rate in the endoscopic treatment group was lower than that in the drug-only treatment group.Conclusions: 1.Compared with drug therapy,endoscopic therapy can significantly reduce the rate of rebleeding within one year after treatment,and gradually decrease with the increase of the number of endoscopic therapy.2.Age,history of previous bleeding,diameter of esophageal varices,ALT as an independent risk factor for predicting rebleeding within 1 year after endoscopic treatment.the number of endoscopic treatments was a protective factor,and the fitted combined prediction was accurate for judging rebleeding.3.Among patients with post-hepatitis B cirrhosis,the rebleeding rate of patients receiving anti-HBV treatment is low.