ObjectiveTo investigate the influencing factors for the clinical effect of emergency endoscopic therapy in the treatment of patients with acute-on-chronic liver failure and gastroesophageal variceal bleeding. MethodsA total of 51 patients with acute-on-chronic liver failure and gastroesophageal variceal bleeding who underwent emergency endoscopic therapy in Beijing Shijitan Hospital and The Fifth Medical Center of Chinese PLA General Hospital from January 2016 to December 2018 were enrolled, among whom 26 had successful hemostasis and 25 had failed hemostasis. The two groups were compared in terms of general information, varices grade and bleeding manifestations under endoscope, blood biochemical parameters, ultrasound findings, Child-Pugh class, and Model for End-Stage Liver Disease (MELD) score, and the influencing factors for the outcome of hemostasis were analyzed. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups; the logistic regression model was used to perform the multivariate analysis. ResultsOf all patients, 26 achieved successful hemostasis, with a success rate of hemostasis of 51%. There were no significant differences between the two groups in sex, age, etiology of liver cirrhosis, presence or absence of liver cancer, presence or absence of portal vein thrombosis, bleeding for the first time or not, white blood cell count, hemoglobin, platelet count, prothrombin time activity, alanine aminotransferase, total bilirubin, albumin, cholinesterase, MELD score, and bleeding site and bleeding manifestations under gastroscope (all P＞0.05). Compared with the failed hemostasis group, the successful hemostasis group had a significantly longer course of disease (t=2.760, P=0.008) and significantly larger portal vein diameter and diameter of varicose veins under endoscope (t=-4.847, χ2=-6.590, both P＜0.05), and the failed hemostasis group had a significantly higher proportion of patients with Child-Pugh class C disease than the successful hemostasis group (χ2=5.684, P=0.017). Course of liver cirrhosis (odds ratio ［OR］=0.913, 95% confidence interval ［CI］: 0.838-0.994, P＜0.05), portal vein diameter (OR=1.925,95%CI: 1.516-2.443, P＜0.05), and diameter of varicose veins (OR=23.254, 95%CI: 2.250-240.352, P＜0.05) were independent influencing factors for the clinical effect of endoscopic hemostasis. ConclusionThere is a relatively low success rate of emergency endoscopic hemostasis in patients with acute-on-chronic liver failure, and course of liver cirrhosis, portal vein diameter, and diameter of varicose veins are independent influencing factors for the clinical effect of endoscopic hemostasis.

[摘 要] 目的：筛选影响胃癌患者预后及治疗的关键基因，分析关键基因微纤维相关蛋白2（MFAP2）在提示胃癌患者预后及免疫治疗敏感性中的价值。方法：从TCGA数据库下载胃癌患者的癌和癌旁组织的表达谱数据及临床资料。综合加权基因共表达网络分析（WGCNA）和单因素Cox回归分析筛选与胃癌预后显著相关的基因。使用多个患者队列评估关键基因MFAP2的预后价值，分析其效能和临床病理指标的相关性。使用多个在线数据库数据及算法分析MFAP2与肿瘤免疫微环境的关联，免疫表型评分（IPS）联合免疫治疗患者队列分析MFAP2在预测免疫治疗响应性中的价值。采用多数据集验证MFAP2在胃癌及癌旁组织中的表达差异。结果：蓝色模块与胃癌患者的生存结局相关性最高（R=0.17，P<0.001）；进一步与预后相关基因取交集，共筛选到20个关键基因。关键基因MFAP2的高表达提示胃癌的不良预后和病理进展（HR>1，P<0.05）。MFAP2与肿瘤相关成纤维细胞密切相关，高表达MFAP2的胃癌患者对免疫治疗更不敏感。多数据集验证结果显示，MFAP2 mRNA在胃癌组织中高表达（P<0.05或P<0.01）。结论：MFAP2的高表达是胃癌预后不良和免疫治疗响应不佳的提示因子，有望作为胃癌的新型治疗靶点和预后标志物。