探讨内镜治疗肝硬化合并食管胃静脉曲张破裂出血（EVB）患者再出血的风险因素，并对应建立预测模型。

回顾性纳入2022年8月至2024年8月于常州市第一人民医院就诊的肝硬化合并EVB患者109例，经内镜治疗后1年随访再出血情况，按治疗后是否再出血分为再出血组（17例）和未再出血组（92例），采用单因素分析临床各项指标与内镜下治疗后再出血的关系，建立预测模型，评估模型拟合度，分析其临床价值。

109例患者经内镜治疗后72 h止血成功率100%，随访1年，其中17例（15.59%）发生再出血。性别、年龄、肝硬化病因、食管静脉曲张程度、胃底静脉曲张、感染、白细胞计数、血小板、尿素氮、肌酐、血清白蛋白、凝血酶原时间、纤维蛋白原、门静脉内径、脾静脉内径及脾脏厚度均与内镜治疗肝硬化合并EVB患者再出血风险无关（P>0.05）；治疗方法、门静脉栓子、总胆红素、血红蛋白、腹水及Child-Pugh分级与内镜治疗肝硬化合并EVB患者再出血风险有关（P<0.05）。Logistic回归分析显示，门静脉栓子、血红蛋白、合并腹水及Child-Pugh分级是内镜治疗肝硬化合并EVB患者再出血的独立危险因素（P<0.05）。基于以上4项指标建立列线图模型，C-index为0.877，校准曲线拟合良好；模型的ROC曲线下面积为0.877（95% CI 0.798~0.928，P<0.001）。

基于门静脉栓子、血红蛋白、合并腹水及Child-Pugh分级构建的列线图，可有效预测内镜治疗肝硬化合并EVB患者再出血风险，具有较好的临床应用价值。

To explore the risk factors of rebleeding in patients with liver cirrhosis complicated with esophageal and gastric varices rupture and bleeding (EVB) treated by endoscopy, and to establish a corresponding predictive model.

A total of 109 patients with liver cirrhosis complicated with EVB who visited the First People's Hospital of Changzhou from August 2022 to August 2024 were retrospectively included. The rebleeding situation was followed up for one year after endoscopic treatment. They were divided into the rebleeding group (17 cases) and the non-rebleeding group (92 cases) according to whether there was rebleeding after treatment. Univariate analysis was used to analyze the relationship between various clinical indicators and rebleeding after endoscopic treatment. A predictive model was established, the model's fit degree was evaluated, and its clinical value was analyzed.

The hemostasis success rate of 109 patients within 72 hours after endoscopic treatment was 100%. During the 1-year follow-up, 17 cases (15.59%) experienced rebleeding. Gender, age, etiology of liver cirrhosis, degree of esophageal varices, gastric fundus varices, infection, white blood cell count, platelet count, urea nitrogen, creatinine, serum protein, prothrombin time, fibrinogen, portal vein diameter, splenic vein diameter and spleen thickness were all not related to the risk of rebleeding in patients with liver cirrhosis complicated with EVB after endoscopic treatment (P>0.05). The treatment methods, portal vein emboli, total bilirubin, hemoglobin, ascites and Child-Pugh classification were related to the risk of rebleeding in patients with liver cirrhosis complicated with EVB treated by endoscopy (P<0.05). The results of Logistic regression analysis showed that portal vein emboli, hemoglobin, combined ascites and Child-Pugh classification were independent risk factors for rebleeding in patients with liver cirrhosis complicated with EVB treated by endoscopy (P<0.05). Based on the above four indicators, a nomogram model was established. The C-index was 0.877, and the calibration curve fitted well. The area under the ROC curve of the model was 0.877 (95% CI: 0.798-0.928, P<0.001).

The nomogram constructed based on portal vein emboli, hemoglobin, combined ascites and Child-Pugh classification can effectively predict the risk of rebleeding in patients with liver cirrhosis complicated with EVB treated by endoscopy, and has good clinical application value.