探讨基于HVPG分层，采取内镜下治疗预防肝硬化静脉曲张患者再出血的中远期疗效。

收集符合入组条件的静脉曲张出血患者，记录经急诊止血治疗后早期再出血的情况，按照HVPG水平将患者分为三组，分别给予不同的二级预防治疗：(1)低HVPG组：HVPG≤16 mmHg，给予内镜下套扎治疗(endoscopic variceal ligation，EVL)；(2)中HVPG组：16 mmHg<HVPG≤20 mmHg，给予部分脾动脉栓塞术(partial splenic embolization，PSE)联合EVL治疗；(3)高HVPG组：HVPG>20 mmHg，行经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt，TIPS)治疗联合EVL治疗。随访期间所有患者均口服非选择性β受体阻滞剂治疗，随访记录各组患者远期再出血和死亡情况。

共入组67例患者(低HVPG组22例，中HVPG组27例，高HVPG组18例)。7例出现早期再出血，其中3例患者HVPG测压值大于12 mmHg，小于等于16 mmHg，4例患者HVPG测压值大于20 mmHg，多因素回归分析显示HVPG值和总胆红素水平是早期再出血的独立危险因素。平均随访时间20.94个月，随访期间共有12例出现远期再出血，低HVPG组，中HVPG组以及高HVPG组2年维持无再出血率分别为86.4% vs.77.4% vs. 83.3%，高、中HVPG组分别与低HVPG组比较，差异均无统计学意义(P>0.05)。

对肝硬化静脉曲张出血的患者，通过基于HVPG压力梯度进行危险分层，采用不同二级预防策略，可以使高HVPG和中HVPG组获得与低HVPG组类似的长期再出血预防效果，即在此治疗模式的指导下，选择EVL联合PSE、TIPS等治疗方式可有效预防静脉曲张再出血。

To investigate the mid- to long-term efficacy of endoscopic treatment based on Hepatic venous pressure gradient (HVPG) stratification in preventing rebleeding in patients with cirrhotic varices.

Patients with variceal bleeding who met the inclusion criteria were enrolled and their early rebleeding status after emergency hemostasis treatment was recorded. Based on HVPG levels, patients were stratified into three groups and received different secondary prevention treatments: (1) Low HVPG group (HVPG ≤ 16 mmHg): endoscopic variceal ligation (EVL); (2) Moderate HVPG group (16 mmHg < HVPG ≤ 20 mmHg): partial splenic embolization (PSE) combined with EVL; (3) High HVPG group (HVPG > 20 mmHg): transjugular intrahepatic portosystemic shunt (TIPS) combined with EVL. All patients received oral non-selective beta-blockers (NSBB) during follow-up, and the occurrence of long-term rebleeding and death was recorded for each group.

A total of 67 patients were enrolled (22 in the low HVPG group, 27 in the moderate HVPG group, and 18 in the high HVPG group). Seven patients experienced early rebleeding, among whom three had HVPG values greater than 12 mmHg but less than or equal to 16 mmHg, and four had HVPG values greater than 20 mmHg. Multivariate regression analysis revealed that HVPG value and total bilirubin level were independent risk factors for early rebleeding. With an average follow-up time of 20.94 months, 12 patients experienced long-term rebleeding. The 2-year probability of maintaining no rebleeding in the low HVPG group, moderate HVPG group, and high HVPG group were 86.4% vs. 77.4% vs. 83.3% respectively, with no statistically significant differences between the high and moderate HVPG groups compared to the low HVPG group (P>0.05), respectively.

For patients with variceal bleeding due to cirrhosis, risk stratification based on HVPG and different secondary prevention strategies can achieve similar long-term rebleeding prevention effects in high and moderate HVPG groups as in low HVPG group. That is, under the guidance of this treatment model, the combination of EVL with PSE, TIPS, and other treatment methods can effectively prevent variceal rebleeding.