探讨影响肝硬化门静脉高压症患者治疗后再出血的危险因素，并构建列线图预测模型。

回顾性分析2015年1月至2020年1月上海交通大学医学院附属第六人民医院诊治的143例肝硬化门静脉高压症患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男77例，女66例；平均年龄（56±12）岁；乙型病毒性肝炎后肝硬化109例。收集患者一般资料、既往病史及入院实验室检测结果等临床资料。随访时间为3年，以治疗后再出血为主要结局事件，根据是否发生再出血分为再出血组（32例）和未出血组（111例）。通过Logistic单因素和多因素回归分析确定再出血相关危险因素，使用逐步回归法进行变量筛选，R软件构建列线图预测模型，通过Bootstrap法进行内部验证，最后根据ROC曲线、校正曲线、临床决策曲线（DCA）分析验证模型的预测效能与临床有效性。

Logistic单因素和多因素回归分析显示，年龄、体重、Child-Pugh分级>A级和手术治疗是肝硬化门静脉高压症患者治疗后再出血的独立影响因素（OR=1.048，0.947，5.980，0.238；P<0.05）。基于4个独立影响因素建立再出血的预测模型列线图，该预测模型ROC曲线下面积为0.806（验证后为0.811），均大于0.75，说明模型区分度较高；Brier分数为0.114（验证后为0.102），均小于0.25，R²为0.437（验证后为0.477），均大于0.4，说明模型校准度较好；模型的DCA曲线净获益均高于两条极端曲线，表明预测模型具有临床有效性。

外科手术是防治肝硬化门静脉高压症患者再出血的重要手段，通过建立列线图预测模型，有助于临床早期识别肝硬化门静脉高压症治疗后再出血的高危患者。

To identify the risk factors of re-hemorrhage in patients with cirrhotic portal hypertension after treatments, and to construct a nomogram prediction model.

Clinical data of143 patients with cirrhotic portal hypertension treated in Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2015 to January 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 77 patients were male and 66 female, aged (56±12) years on average. 109 cases were diagnosed with liver cirrhosis after hepatitis B. Baseline data, medical history and laboratory examination results upon admission were collected. Follow-up time was 3 years. Re-hemorrhage after treatments was regarded as the main outcome event. All patients were divided into the re-hemorrhage (n=32) and non-hemorrhage groups (n=111) according to the incidence of re-hemorrhage. The risk factors of re-hemorrhage were identified by Logistic univariate and multivariate regression analyses. Relevant variables were screened by stepwise regression method. Nomogram prediction model was constructed by R software, and internal verification was carried out by Bootstrap method. Finally, the prediction efficiency and clinical effectiveness of this model were analyzed and validated based on the ROC curve, calibration curve and decision curve analysis (DCA).

Logistic univariate and multivariate regression analyses showed that age, weight, Child-Pugh grading above grade A and surgical treatment were the independent influencing factors of re-hemorrhage in patients with cirrhotic portal hypertension after treatment (OR=1.048, 0.947, 5.980, 0.238; P<0.05). Based on 4 independent influencing factors, the nomogram prediction model for re-hemorrhage was constructed. The area under the ROC curve of this prediction model was 0.806 (0.811 after validation), both of which were >0.75, indicating that this prediction model yielded high discrimination. Brier score was calculated as 0.114 (0.102 after validation), equally <0.25, and R² was 0.437 (0.477 after validation), equally >0.4, suggesting that the model had high calibration. The net benefit of DCA curve of this model was higher than those of two extreme curves, indicating that the prediction model had clinical effectiveness.

Surgery is an important approach to prevent and treat re-hemorrhage in patients with cirrhotic portal hypertension. Constructing nomogram prediction model contributes to identifying high-risk post-treatment re-hemorrhage patients with cirrhotic portal hypertension at early clinical stage.