探讨门静脉高压症消化道出血胃镜治疗的时机及抗凝血酶Ⅲ在预测患者活动性出血中的价值。

回顾性分析2018年8月至2025年3月在上海中医药大学附属曙光医院行急诊胃镜治疗的152例肝硬化门静脉高压症消化道出血患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男104例，女48例，年龄32~74岁，中位年龄57岁。根据是否检出活动性出血分为2组，分析消化道出血急诊检出率、麻醉实施率、再次治疗率、再出血率、止血成功率、并发症等；同时根据是否麻醉分为2组，分析麻醉对于门静脉高压症消化道出血急诊胃镜的影响；分析凝血功能主要指标与活动性出血的关系。

本研究中152例患者出血检出率为48.0%（73/152）；活动性出血组麻醉实施率为30.1%（22/73），明显低于无活动性出血组的60.8%（48/79）（χ²=14.321，P<0.05）；活动性出血组再次治疗率为84.9%（62/73），明显高于无活动性出血组的40.5%（32/79）（χ²=31.732，P<0.05）；再出血率为23.3%（17/73），明显高于无活动性出血组的10.1%（8/79）（χ²=4.782，P<0.05）。麻醉组再次治疗率为42.9%（30/70），明显低于未麻醉组的70.0%（64/82）（χ²=19.819，P<0.05）；再出血率为8.6%（6/70），明显低于未麻醉组的23.2%（19/82）（χ²=5.857，P<0.05）。活动性出血组抗凝血酶Ⅲ为44.3(29.1，48.4)%，明显低于无活动性出血组的75.8 (55.9，88.3)%（Z=-6.095，P<0.05）。ROC曲线分析显示，抗凝血酶Ⅲ对活动性出血具有一定预测诊断价值，AUC为0.786，灵敏度0.899、特异度0.784，准确率84.2%。抗凝血酶Ⅲ诊断的最佳界值50.9%。

对于门静脉高压症消化道出血患者，当患者生命体征平稳时，完善术前准备和麻醉评估后再进行急诊胃镜治疗患者获益明显。抗凝血酶Ⅲ对患者活动性出血具有一定预测价值，可作为胃镜治疗时机选择的参考依据。

To investigate the timing of gastroscopy for gastrointestinal bleeding induced by portal hypertension and the application value of antithrombin Ⅲ in predicting active bleeding.

Clinical data of 152 cirrhosis-induced portal hypertension patients experiencing gastrointestinal bleeding who underwent emergency gastroscopy in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from August 2018 to March 2025 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 104 patients were male and 48 female, aged from 32 to 74 years, with a median age of 57 years. All patients were divided into two groups according to whether active bleeding was found. Emergency detection rate of gastrointestinal bleeding, implementation rate of anesthesia, re-treatment rate, rebleeding rate, hemostasis success rate and incidence of complications were analyzed. All patients were divided into two groups according to whether they were anesthetized or not. The impact of anesthesia on emergency gastroscopy for gastrointestinal bleeding was assessed in portal hypertension patients. The relationship between the main indexes of coagulation function and active bleeding was analyzed.

The detection rate of gastrointestinal bleeding in 152 patients was 48.0%(73/152). The implementation rate of anesthesia in the active bleeding group was 30.1%(22/73), significantly lower than 60.8%(48/79) in the non-active bleeding group (χ²=14.321, P<0.05). The re-treatment rate in the active bleeding group was 84.9%(62/73), significantly higher than 40.5%(32/79) in the non-active bleeding group (χ²=31.732, P<0.05). The rebleeding rate was 23.3%(17/73), significantly higher than 10.1%(8/79) in the non-active bleeding group (χ²=4.782, P<0.05). In the anesthesia group, the re-treatment rate was 42.9%(30/70), significantly lower than 70.0%(64/82) in the non-anesthesia group (χ²=19.819, P<0.05). The rebleeding rate was 8.6%(6/70), significantly lower than 23.2%(19/82) in the non-anesthesia group (χ²=5.857, P<0.05). In the active bleeding group, the antithrombin Ⅲ was 44.3(29.1, 48.4)%, significantly lower than 75.8 (55.9, 88.3)% in the non-active bleeding group, and the difference was statistically significant (Z=-6.095, P<0.05). ROC curve analysis showed that antithrombin Ⅲ had certain predictive and diagnostic value for active bleeding, with an AUC of 0.786, a sensitivity of 0.899, a specificity of 0.784 and an accuracy of 84.2%, respectively. The optimal cut-off value of antithrombin Ⅲ diagnosis was 50.9%.

For patients with gastrointestinal bleeding induced by portal hypertension, significant clinical benefits can be obtained from emergency gastroscopy after full preoperative preparation and anesthesia evaluation when vital signs are stable. Antithrombin Ⅲ has certain predictive value for patients with active bleeding, which can be used as a reference marker for the timing of gastroscopy.