目的 探讨肝脏/脾脏体积比值（liver-to-spleen volume ratio， LSVR）联合血浆纤维蛋白原水平（fibrinogen， FIB）对肝硬化患者食管胃底静脉曲张破裂出血（esophagogastric variceal bleeding， EGVB）风险的预测效能。 方法 采用回顾性病例分析设计，将纳入2020年1月至2022年12月期间在南通市第三人民医院收治的肝硬化合并EGVB患者130例作为观察组。收集患者的临床资料、血常规、血清生化及血凝、CT等检查结果。根据1年内的预后情况将患者分为未出血组（n = 71）和再出血组（n = 59），对于连续变量比较，符合正态分布的变量，采用两样本均数比较的t检验；非正态分布变量，则使用非参数秩和检验；对于分类变量比较，根据数据分布情况，选择χ²检验或Fisher确切概率法进行分析，而后采用logistic回归模型建立LSVR联合FIB的预测模型；ROC曲线分析LSVR、FIB单独及联合的临床效能。计算LSVR联合FIB预测EGVB预后的最佳临界值，Kaplan-Meier法绘制生存曲线。 结果 两组患者AST、FIB、D-二聚体、MELD、ALBI评分、SV、LSVR门静脉直径、脾静脉直径比较差异均有统计学意义（P < 0.05）。多因素分析显示 LSVR（OR = 3.347，95%CI：1.624 ~ 6.899，P = 0.001）和FIB（OR = 0.206，95%CI：0.078 ~ 0.544，P = 0.001）是影响EGVB患者预后的独立危险因素。LSVR联合FIB的ROC曲线下面积（AUC）最大（AUC = 0.825，95%CI：0.751 ~ 0.899），高于单独 LSVR（AUC = 0.731，95%CI：0.639 ~ 0.822）和FIB（AUC = 0.683，95%CI：0.589 ~ 0.777）。LSVR联合FIB最佳临界值为-2.741，特异度为81.7%，敏感度为74.6%，Kaplan-Meier生存分析显示，LSVR联合FIB < -2.741的患者1年未出血率为53.4%（39/73），显著高于LSVR联合FIB ≥ 2.741患者的7.0%（4/57），差异有统计学意义（P < 0.001）。 结论 LSVR联合FIB可以提高单独LSVR和FIB预测EGVB患者1年发生再出血的预测效能。这一模型可能作为一个客观、简单的模型可更好的应用于临床。

Objective To evaluate the utility of the liver-spleen volume ratio and fibrinogen in predicting the risk of esophagogastric variceal bleeding in patients with cirrhosis. Methods A total of 130 cirrhotic patients with esophagogastric variceal bleeding were recruited from among those admitted to Nantong Third People's Hospital between January 2020 and December 2022. Clinical data， blood test results， biochemical assay findings， coagulation test outcomes， and computed tomography （CT） scan results were collected. Based on their 1-year prognosis， the patients were classified into a non-bleeding group （n = 71） and a re-bleeding group （n = 59）. For normally distributed continuous variables， an independent samples t-test was employed； for non-normally distributed continuous variables， the Mann-Whitney U test was used； and for categorical variables， the chi-square test or Fisher's exact probability test was applied. Multivariable analysis was conducted to identify independent risk factors for esophageal and gastric variceal bleeding （EGVB） in cirrhotic patients. A predictive model integrating the liver-to-spleen volume ratio （LSVR） and fibrinogen （FIB） was then established. The clinical effectiveness of LSVR， FIB alone， and their combination was evaluated using receiver operating characteristic （ROC） curve analysis. The optimal cut-off value of the combined LSVR and FIB for predicting the prognosis of EGVB was calculated， and survival curves were plotted using the Kaplan-Meier method. Results Clinically relevant differences were observed in AST， FIB， D-dimer， MELD， ALBI scores， spleen volume， and the liver-to-spleen volume ratio between the two groups （P < 0.05）. Multivariable analysis indicated that LSVR （OR = 3.347， 95%CI： 1.624 ~ 6.899， P = 0.001） and FIB （OR =0.206， 95% CI： 0.078 ~ 0.544， P = 0.001） were independent risk factors for the prognosis of EGVB. The area under the receiver operating characteristic curve （AUC） was the largest when LSVR was combined with FIB （AUC = 0.825， 95% CI： 0.751 ~ 0.899）， which was higher than that of LSVR alone （AUC = 0.731， 95%CI： 0.639 ~0.822） and FIB alone （AUC = 0.683， 95%CI： 0.589 ~ 0.777）. The optimal cutoff value of the combination of LSVR and FIB was -2.741， with a specificity of 81.7% and a sensitivity of 74.6%. Kaplan-Meier survival analysis demonstrated that patients with LSVR combined with FIB < -2.741 had a 1-year non-bleeding rate of 53.4% （39/73）， which was significantly higher than the 7.0% （4/57） in patients with LSVR combined with FIB ≥ -2.741， and the difference was statistically significant （P < 0.001）. Conclusions Compared with using LSVR or FIB alone， combining LSVR with FIB enhances the predictive efficacy for 1-year re-bleeding in EGVB patients. This model could serve as an objective and straightforward tool for better clinical implementation.