The Establishment Of A Model For Predicting EGVB Rebleeding In Cirrhosis And The Therapeutic Role Of Traditional Chinese Medicine Based On Real World

Esophagogastric variceal bleeding(EGVB)in patients with cirrhosis is one of the most common and severe complications of portal hypertension,as well as a high risk for rebleeding.Rebleeding is relevant to significant morbidity and mortality.How to predict EGVB rebleeding more accurately and take active intervention is a puzzling problem for clinicians.Therefore,the establishment of a predictive scoring model to predict the risk of rebleeding is essential to take active secondary prevention and reduce the risk of rebleeding and mortality.And the study of the protective effect of traditional Chinese medicine(TCM)on EGVB rebleeding is very important to improve the basic state of liver and reduce the side effects of western medicine preventive measures.OBJECTIVES1 Investigate the influencing factors of rebleeding in EGVB patients within 1-year and establish a non-invasive scoring model for 1-year rebleeding.2 Investigate the effect of endoscopy combined with anti-fibrosis TCM on 1-year rebleeding in EGVB patients.METHODS1 A retrospective study of 704 patients with EGVB from August 2008 to October 2016 in the Beijing Ditan Hospital.The patients were followed up for one year.The COX univariate and multivariate analysis were used to analyze the independent factors of affecting the EGVB rebleeding within 1-year.Finally,the prediction model of 1-year rebleeding in patients with EGVB was established.2 A retrospective study of 615 patients with EGVB from August 2008 to October 2016 in the Beijing Ditan Hospital.All patients included received endoscopy therapy.According to whether combination of anti-fibrosis TCM treatment,there were 153 patients in TCM cohort and 462 patients in non-TCM cohort.The rate of rebleeding was observed in two treatment cohorts.RESULTS1 By COX univariate and multivariate analysis in 704 patients with EGVB was carried out.We found that CHB,TBIL,GLU,INR,TCM and probiotics treatment were independent factors for EGVB rebleeding within 1-year(P<0.05).COX multivariate analysis was carried out after the significant continuous multivariate variables(TBIL,GLU,INR)was transformed into classification variables.Six independent predictors related to rebleeding within 1-year in patients with EGVB were determined and a scoring model was established.The scoring model:TBIL<65umol/L was 0,TBIL>65umol/L was 2;INR<1.4 was 0,INR ≥1.4 was 1;CHB was 0,no CHB was 1;GLU<8.8mmol/L was 0,GLU ≥ 8.8mmo/L was 1;no probiotics treatment was 2,probiotic treatment was 0;no CTM treatment was 2,TCM treatment was 0.The model score ranges from 0 to 9.The area under ROC of this scoring model was 0.653.According to the cut-off value,the patients with EGVB were divided into high risk group(with predictive score ≥ 5)and low risk group(with predictive score<5).There was a significant difference in the rate of rebleeding between the two groups(66.2%vs.40.0%;log rank P<0.001).2 The COX univariate and multivariate analysis were performed in 615 patients with EGVB.After adjusting for other factors,the anti-fibrosis TCM therapy was still an independent protective factor for EGVB rebleeding in patients with EGVB for 1-year(HR = 0.656,95%CI = 0.495-0.871,P = 0.002).Kaplan-Meier analysis showed that combined anti-fibrotic TCM therapy could significantly reduce the risk of EGVB rebleeding(P = 0.001).And with the increase of dose level,the rebleeding rate was reduced.The rebleeding rate of 28-90cDDD,91-180cDDD and>180cDDD dose group was 56.7%,35.3%and 6.9%(P = 0.001)respectively.In any Child-Pugh group,the rebleeding rate of patients treated with TCM was significantly lower than that of patients without TCM:Child-Pugh A(49.5%vs.38.2%,P = 0.237);Child-Pug h B(56.2%vs.41.8%,P = 0.007);Child-Pugh C(67.2%vs.50.0%,P = 0.101).Studies at different etiological levels found that for EGVB patients of any etiology combined TCM therapy reduced their risk of rebleeding,but only in ALD level there were significant statistical differences:CHB(50.5%vs.42.9%,P = 0.217);CHC(65.2%vs.44.4%,P = 0.128),ALD(65.1%vs.47.5%,P = 0.047)and AIH(52.2%vs.30.8%,P = 0.214).For the patients who have rebleeding,the time of rebleeding can be significantly delayed by the application of anti-fibrosis TCM(P-0.003).CONCLUSION1 Baseline TBIL,INR,GLU level,etiology of CHB,TCM therapy and probiotics therapy were independent influencing factors of rebleeding in EGVB patients within 1-year.The prediction model builted on this basis can well identify the high risk population of rebleeding within 1-year.And the predictive model is suited for patients with EGVB at different liver function level(Child-Pugh A,B,C)and different underlying etiology(CHB,CHC,ALD,AIH).2 Endoscopy combined with TCM to prevent EGVB patients with cirrhosis can significantly reduce their risk of rebleeding within 1-year.And the effect of TCM needs to reach a certain dose.when the dose>90cDDD,the effect is obvious and the greater the dose is,the more significant the effect is.The study also found that the effect of TCM on EGVB patients with ALD and Child-Pugh B was significant.Combination TCM therapy can not only reduce the risk of rebleeding but delay the time of rebleeding.