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摘要：
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摘要：目的 观察代偿期肝硬化患者血清前白蛋白（prealbumin，PA）及血浆纤维蛋白
原（fibrinogen，FIB）水平，分析其与代偿期肝硬化患者发生食管静脉曲张的关系。方
法 采取前瞻性研究，选择2021年11月至2022年6月于保定市人民医院接受治疗的100例
代偿期肝硬化患者作为研究对象。所有患者入院时均接受胃镜检查，根据食管静脉曲
张发生情况分为食管静脉曲张组和无食管静脉曲张组。统计患者基线资料并检测血清
PA和血浆FIB水平，采用Logistic回归分析代偿期肝硬化食管静脉曲张的影响因素，采
用受试者工作特征（receiver operator characteristic，ROC）曲线评估PA、FIB水平对代
偿期肝硬化患者食管静脉曲张发生的预测价值，采用限制性立方样条法分析PA及FIB
水平与代偿期肝硬化食管静脉曲张发生的剂量反应关系。结果 100例代偿期肝硬化患
者经胃镜检查，确诊食管静脉曲张43例，发生率43.00%；食管静脉曲张组患者Child-Pugh C级
占比高于无食管静脉曲张组 [39.53%（17/43）比17.54%（10/57）]，入院时血清PA
[（79.18 ± 18.76）mg/L比（101.06 ± 21.57）mg/L]、血浆FIB水平 [（1.52 ± 0.42）g/L
比（2.15 ± 0.83）g/L] 低于无食管静脉曲张组，差异均有统计学意义（P均＜ 0.05）。
Logistic回归分析表明Child-Pugh C级是代偿期肝硬化患者食管静脉曲张发生的危险因素
（OR = 6.518，95% CI：1.518～27.981，P = 0.012）；入院时血清PA、血浆FIB高表达
是保护因素（OR = 0.934，95%CI：0.905～0.964，P ＜ 0.001；OR = 0.109，95%CI：
0.034～0.344，P ＜ 0.001）。PA、FIB值及二者联合预测代偿期肝硬化患者食管静脉曲
张发生的ROC曲线下面积分别为0.792、0.756、0.857，联合预测的曲线下面积显著高于
FIB单独预测（z = 1.683，P = 0.046），与单独PA比较差异无统计学意义（z = 1.113，P =
0.266）。限制性立方样条法结果显示，PA、FIB水平与代偿期肝硬化患者食管静脉曲张
发生的关联强度呈线性剂量反应关系（P ＜ 0.05），PA、FIB水平与代偿期肝硬化患者食
管静脉曲张发生呈负相关，代偿期肝硬化患者食管静脉曲张发生风险随PA、FIB升高而降
低。结论 PA及FIB水平与代偿期肝硬化患者食管静脉曲张的发生可能存在一定关联。
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Abstract: Objective To observe the levels of serum prealbumin (PA) and plasma fibrinogen
(FIB) in patients with compensated liver cirrhosis, and analyze the relationship between PA
and FIB and the occurrence of esophageal varices in patients with compensated liver cirrhosis.
Methods In a prospective study, 100 patients with compensated liver cirrhosis who were
treated in Baoding People’s Hospital from November 2021 to June 2022 were selected as the
study subjects. All patients received gastroscopy at admission and divided into esophageal
varices group and non-esophageal varices group according to the occurrence of esophageal
varices. The baseline data was counted and serum PA and plasma FIB levels were measured.
Logistic regression analysis was used to analyze the influencing factors of esophageal varices
in patients with compensated cirrhosis. The receiver operating characteristic (ROC) curve was
used to evaluate the predictive value of PA and FIB levels on the occurrence of esophageal
varices in patients with compensated cirrhosis. The dose-response relationship between
PA and FIB levels and the occurrence of esophageal varices in compensated cirrhosis was
analyzed by restricted cubic spline method. Results Total of 43 cases of esophageal varices
were diagnosed by gastroscopy in 100 patients with compensated liver cirrhosis, the incidence
was 43.00%. The proportion of Child-Pugh grade C in esophageal varices group was higher
than that in non-esophageal varices group [39.53% (17/43) vs. 17.54% (10/57)], and the levels
of serum PA [(79.18 ± 18.76) mg/L vs. (101.06 ± 21.57) mg/L] and plasma FIB [(1.52 ± 0.42) g/L
vs. (2.15 ± 0.83) g/L] at admission were lower than those in non-esophageal varices group, the
differences were statistically significant (all P ＜ 0.05). Logistic regression analysis showed
that Child-Pugh grade C was a risk factor for esophageal varices in patients with compensated
cirrhosis (OR = 6.518, 95%CI: 1.518～27.981, P = 0.012), while the high expression of serum
PA and plasma FIB on admission were protective factors (OR = 0.934, 95%CI: 0.905～0.964,
P ＜ 0.001; OR = 0.109, 95%CI: 0.034～0.344, P ＜ 0.001). The area under the ROC curve
of PA, FIB and PA + FIB on predicting the occurrence of esophageal varices in patients with
compensated cirrhosis were 0.792, 0.756 and 0.857, respectively. The area under the ROC
curve of PA + FIB was significantly higher than that of FIB (z = 1.683, P = 0.046), while
had no statistically significant difference compared with that of PA (z = 1.683, P = 0.046).
Restricted cubic spline showed that there was a linear dose-response relationship between
PA and FIB levels and the occurrence of esophageal varices in patients with compensated
cirrhosis (P ＜ 0.05). PA and FIB levels were negatively correlated with the occurrence of
esophageal varices in patients with compensated cirrhosis. The risk of esophageal varices
in patients with compensated cirrhosis decreased with the increasing of PA and FIB level.
Conclusion There may be a certain correlation between PA and FIB levels and the occurrence
of esophageal varices in patients with compensated liver cirrhosis.
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