transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2024-16-4-507-518transplantologiya-944Research ArticleОПЫТ ПРАКТИЧЕСКОЙ ТРАНСПЛАНТОЛОГИИEXPERIENCE IN PRACTICAL TRANSPLANTOLOGYНеинвазивные предикторы первого эпизода кровотечения из варикозных вен пищевода у больных циррозом печени, ожидающих трансплантациюNon-invasive predictors of the first episode of bleeding from esophageal varices in patients with liver cirrhosis awaiting transplantationhttps://orcid.org/0000-0003-3205-4647КоробкаВ. Л.KorobkaV. L.

Вячеслав Леонидович Коробка - проф., д-р мед. наук, главный врач ГБУ РО «Ростовская областная клиническая больница»; заведующий кафедрой реконструктивной, сердечно-сосудистой, торакальной, челюстно-лицевой хирургии и трансплантологии ФГБОУ ВО «Ростовский государственный медицинский университет» МЗ РФ.

344015, Ростов-на-Дону, Благодатная ул., д. 170; 344022, Ростов-на-Дону, Нахичеванский пер., д. 29

Vyacheslav L. Korobka - Prof., Dr. of Sci. (Med.), Head Physician of the Rostov Regional Clinical Hospital; Head of the Department of Reconstructive, Cardiovascular, Thoracic, Maxillofacial Surgery and Transplantology, RSMU.

170 Blagodatnaya St., Rostov-on-Don 344015; 29 Nakhichevanskiy Ln., Rostov-on-Don 344022

korobka_vl@rostgmu.ruhttps://orcid.org/0000-0002-3752-3193ХоронькоЮ. В.KhoronkoYu. V.

Юрий Владиленович Хоронько - проф., д-р мед. наук, заведующий кафедрой оперативной хирургии и топографической анатомии, врач хирург хирургического отделения.

344022, Ростов-на-Дону, Нахичеванский пер., д. 29

Yuriy V. Khoronko - Prof., Dr. of Sci. (Med.), Head of the Department of Operative Surgery and Clinical Anatomy.

29 Nakhichevanskiy Ln., Rostov-on-Don 344022

khoronko507@gmail.comhttps://orcid.org/0000-0003-2280-3931ПасечниковВ. Д.PasechnikovV. D.

Виктор Дмитриевич Пасечников - проф., д-р мед. наук, врач гастроэнтеролог гастроэнтерологического отделения Центра хирургии и координации донорства (областного) ГБУ РО «Ростовская областная клиническая больница»; профессор кафедры терапии с курсом диетологии ФГБОУ ВО «Ставропольский ГМУ» МЗ РФ.

344015, Ростов-на-Дону, Благодатная ул., д. 170; 355017, Ставрополь, ул. Мира, д. 310

Viktor D. Pasechnikov - Prof., Dr. of Sci. (Med.), Gastroenterologist, Gastroenterological Department of the Center for Surgery and Donation Coordination, RSMU; Professor of the Department of Therapy with the Course of Dietetics, Stavropol SMU.

170 Blagodatnaya St., Rostov-on-Don 344015; 310 Mir St., Stavropol 355017

passetchnikov@mail.ruhttps://orcid.org/0000-0002-4489-4232КоробкаР. В.KorobkaR. V.

Роман Вячеславович Коробка - канд. мед. наук, директор Центра хирургии и координации донорства ГБУ РО «Ростовская областная клиническая больница»; доцент кафедры реконструктивной, сердечно-сосудистой, торакальной, челюстно-лицевой хирургии и трансплантологии ФГБОУ ВО «Ростовский ГМУ» МЗ РФ.

344015, Ростов-на-Дону, Благодатная ул., д. 170; 344022, Ростов-на-Дону, Нахичеванский пер., д. 29

Roman V. Korobka - Cand. Sci. (Med.), Director of the Center for Surgery and Donation Coordination, Rostov Regional Clinical Hospital; Associate Professor of the Department of Reconstructive, Cardiovascular, Thoracic, Maxillofacial Surgery and Transplantology, RSMU.

170 Blagodatnaya St., Rostov-on-Don 344015; 29 Nakhichevanskiy Ln., Rostov-on-Don 344022

roman_korobka@icloud.comhttps://orcid.org/0000-0002-0737-7455МалеванныйМ. В.MalevannyM. V.

Михаил Владимирович Малеванный - канд. мед. наук, заведующий отделением рентгенохирургических методов диагностики и лечения № 2 ГБУ РО «Ростовская ОКБ»; ассистент кафедры реконструктивной, сердечно-сосудистой, торакальной, челюстно-лицевой хирургии и трансплантологии ФГБОУ ВО «Ростовский ГМУ» МЗ РФ.

344015, Ростов-на-Дону, Благодатная ул., д. 170; 344022, Ростов-на-Дону, Нахичеванский пер., д. 29

Mikhail V. Malevanny - Cand. of Sci. (Med.), Head of the Department of X-Ray Surgery N 2, Rostov Regional Clinical Hospital; Teaching Assistant at the Department of Reconstructive, Cardiovascular, Thoracic, Maxillofacial Surgery and Transplantology, RSMU.

 

170 Blagodatnaya St., Rostov-on-Don 344015; 29 Nakhichevanskiy Ln., Rostov-on-Don 344022

doctorm.m@mail.ruhttps://orcid.org/0000-0002-9552-2666ПакЕ. С.PakE. S.

Екатерина Сергеевна Пак - канд. мед. наук, заведующая гастроэнтерологическим отделением Центра хирургии и координации донорства (областного) ГБУ РО «Ростовская ОКБ»; ассистент кафедры реконструктивной, сердечно-сосудистой, торакальной, челюстно-лицевой хирургии и трансплантологии ФГБОУ ВО «Ростовский ГМУ» МЗ РФ.

344015, Ростов-на-Дону, Благодатная ул., д. 170; 344022, Ростов-на-Дону, Нахичеванский пер., д. 29

Ekaterina S. Pak - Cand. Sci. (Med.), Chief of Gastroenterology Department of the Center for Surgery and Donation Coordination of Rostov Regional Clinical Hospital; Teaching Assistant at the Department of Reconstructive, Cardiovascular, Thoracic, Maxillofacial Surgery and Transplantology, RSMU.

170 Blagodatnaya St., Rostov-on-Don 344015; 29 Nakhichevanskiy Ln., Rostov-on-Don 344022

katya_pack-k@mail.ruhttps://orcid.org/0000-0001-7302-3690ПасечниковД. В.PasechnikovD. V.

Дмитрий Викторович Пасечников - канд. мед. наук, доцент кафедры терапии с курсом диетологии.

355017, Ставрополь, ул. Мира, д. 310

Dmitriy V. Pasechnikov - Cand. Sci. (Med.), Associate Professor of the Department of Therapy with the Course of Dietetics.

310 Mir St., Stavropol 355017

spicher@mail.ruГБУ РО «Ростовская областная клиническая больница»; ФГБОУ ВО «Ростовский государственный медицинский университет» МЗ РФРоссияRostov Regional Clinical Hospital; Rostov State Medical UniversityRussian FederationФГБОУ ВО «Ростовский государственный медицинский университет» МЗ РФРоссияRostov State Medical UniversityRussian FederationГБУ РО «Ростовская областная клиническая больница»; ФГБОУ ВО «Ставропольский государственный медицинский университет» МЗ РФРоссияRostov Regional Clinical Hospital; Stavropol State Medical UniversityRussian FederationФГБОУ ВО «Ставропольский государственный медицинский университет» МЗ РФРоссияStavropol State Medical UniversityRussian Federation202417122024164507518Copyright © Коробка В.Л., Хоронько Ю.В., Пасечников В.Д., Коробка Р.В., Малеванный М.В., Пак Е.С., Пасечников Д.В., 20242024Коробка В.Л., Хоронько Ю.В., Пасечников В.Д., Коробка Р.В., Малеванный М.В., Пак Е.С., Пасечников Д.В.Korobka V.L., Khoronko Y.V., Pasechnikov V.D., Korobka R.V., Malevanny M.V., Pak E.S., Pasechnikov D.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/944Введение

Введение. К настоящему времени предложены различные неинвазивные методики или тесты, способные выявить высокий риск кровотечений из варикозно расширенных вен пищевода. Несмотря на значительное количество исследований, выявляющих наличие варикозных узлов как вероятного фактора для развития кровотечения вследствие их разрыва, данные о предикторах первого эпизода кровотечения малочисленны и, нередко, противоречивы.

Цель

Цель. Определить неинвазивные независимые предикторы первого эпизода кровотечения у больных, находящихся в листе ожидания трансплантации печени.

Материал и методы

Материал и методы. Проведено сравнительное ретроспективное исследование 729 пациентов с декомпенсированным циррозом печени, находившихся в листе ожидания трансплантации печени. Произведен анализ демографических, клинических и лабораторных показателей, индексов MELD-Na, Child–Turcotte–Pugh, индекса FIB-4, APRI, LSPS, индекса соотношения количества тромбоцитов/диаметр селезенки, соотношения АСТ/ АЛТ, а также определение жесткости печени, диаметра селезенки в группах пациентов с развившимся первым эпизодом кровотечения (n=334) и без него (n=395). Накопленные риски в сравниваемых группах оценивали c помощью модели пропорциональных рисков (регрессии Кокса) в однофакторном и многофакторном анализах.

Результаты

Результаты. В течение 48 месяцев наблюдения от момента включения пациента в лист ожидания трансплантации печени в 45,8% развились первичные кровотечения. Риск развития первого эпизода кровотечения прогрессивно нарастает при LSPS>3,5 и достигает максимальных значений у пациентов, ожидающих трансплантацию печени в сроки до 48 месяцев от времени включения в лист ожидания, в то время как при LSPS <3,5 риск минимален.

Выводы

Выводы. Независимыми неинвазивными предикторами первого эпизода кровотечения являются: высокий уровень АСТ, высокий показатель фиброза (FIB-4), снижение соотношения количества тромбоцитов/диаметр селезенки и высокая градация показателя LSPS. Применение их в клинической практике позволит улучшить результаты диспансерного и скринингового обследования пациентов с портальной гипертензией.

Background

Background. To date, various non-invasive techniques or tests have been proposed that can identify a high risk of bleeding from esophageal varices. Despite a significant number of studies revealing the presence of venous varices as a likely factor for the development of bleeding due to their rupture, data on predictors of the first episode of bleeding are few and often contradictory.

Objective

Objective. To determine non-invasive independent predictors of the first episode of bleeding in patients waiting for liver transplantation.

Material and methods

Material and methods. A comparative retrospective study was conducted in 729 patients with decompensated cirrhosis who were on the waiting list for liver transplantation. We analyzed demographic, clinical and laboratory parameters, MELD-Na, Child-Turcotte-Pugh scores, FIB-4 Index, APRI, AST/ALT ratio; we determined the liver stiffness, spleen diameter, studied the liver stiffness-spleen diameter to platelet ratio risk score (LSPS model), platelet count/spleen diameter ratio in the groups of patients with the first episode of bleeding (n=334) and without it (n=395). The accumulated risks in the compared groups were assessed using a model of proportional hazards (Cox regression) in univariate and multivariate analysis.

Results

Results. During 48 months of follow-up from the time of patient placement on the liver transplant waiting list, primary bleeding events developed in 45.8%. The risk of developing the first episode of bleeding progressively increased with LSPS >3.5 and reached maximum values in patients awaiting liver transplantation within 48 months of inclusion in the waiting list, while with LSPS <3.5 the risk was minimal.

Conclusion

Conclusion. Independent non-invasive predictors of the first episode of bleeding are a high level of AST, a high fibrosis index (FIB-4), a decrease in the ratio of platelet count/spleen diameter and a high LSPS value. Their application in clinical practice will improve the results of dispensary and screening examinations of patients with portal hypertension.

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The authors declare that there are no conflicts of interest present.