肝储备功能对肝硬化食管静脉曲张破裂出血风险及预后的评估价值  

Value of Liver Reserve Function in Evaluation of Hemorrhage Risk and Prognosis of Cirrhosis with Esophogeal Varices Bleeding

作　　者：林晓晓[1] 林春景[1] 李佳[1] 金尹[1] 吴建胜[1] 

机构地区：[1]温州医科大学附属第一医院消化内科,325000

出　　处：《医学研究杂志》2014年第1期84-88,共5页Journal of Medical Research

摘　　要：目的探讨肝储备功能对肝硬化食管静脉曲张破裂出血（esophageal varices bleeding，EVB）风险及预后的评估价值。方法回顾性分析笔者医院2009年9月～2012年2月收住的283例肝硬化食管静脉曲张患者的临床资料。根据入院时有无合并EVB分为出血组（n=168）和非出血组（n=115），比较两组人院当时肝储备功能评估结果，以多因素Logistic回归模型寻找肝硬化并发EVB的危险因素，并对经药物或手术控制出血后的患者随访观察1年，分析不同程度肝储备功能及入院后治疗方式对EVB患者预后的影响。结果出血组的肝储备功能相关因素中总胆固醇、纤维蛋白原均低于非出血组。而吲哚菁绿15分钟滞留率（indocyanine green retention rate at 15 minutes，ICG—R15）、门静脉宽度及脾脏厚度均高于非出血组，差异有统计学意义（P〈0．05），上述结果经Logistic回归分析得出总胆固醇、纤维蛋白原、ICG—R15、脾脏厚度是食管静脉曲张破裂出血的独立危险因素，OR值分别为0．561、0．643、1．022、1．045。在分别给予药物及手术治疗的两个治疗组中。ICG—R15在再出血患者及非再出血患者之间有统计学差异（P〈0．05），总胆固醇、纤维蛋白原、脾脏厚度在两者之间无统计学差异（P〉0．05）。两组1年内再出血率随着ICG—R15程度的上升而增加，同等程度ICG—R15水平，药物治疗组的再出血率大于手术治疗组。结论总胆固醇、纤维蛋白原、ICG—R15、脾脏厚度是肝硬化食管静脉曲张破裂出血的独立危险因素。EVB患者1年内的再出血率随ICG—R15增大而增加，手术治疗组的再出血率低于药物治疗组，EVB患者ICG—R15及治疗方式与预后密切相关，是预后评估的重要指标。Objective To investigate the assessment value of liver reserve function for hemorrhage risk and prognosis in cirrhosis pa- tients with esophogeal varices bleeding（ EVB ）. Methods A total of 283 liver cirrhosis patients with esophogeal varices were divided into two groups, the bleeding group （ n = 168 ） and non - bleeding group （ n = 115 ）. We compared their liver reserve function and explored the risk factors of EVB by multivariate non - coudinatonal Logistic regression analysis. The EVB patients were followed up for one year after bleeding be controlled by drugs or operations, then the effects of different liver reserve function and treatment methods on prognosis of EVB were discussed. Results Single factor analysis showed that, the total cholesterol and fibrinogen in bleeding group were lower than in non -bleeding group,but ICG- R15, portal vein diameters and splenic thick were higher, and there was significant difference（P 〈 O. 05）. Then multivariate non -condinatonal logistic regression analysis showed that total cholesterol, fibrinogen, ICG - R15, splenic thick were independent risk factors of EVB, and the OR values were 0. 561,0. 643, 1. 022,1. 045. Whether in drug therapy group or operation therapy group, there was significant difference （P 〈 0.05） in ICG- R15 between rebleeding patients and non- rebleeding patients,but not total cholesterol,fibrinogen and splenic thick（ P 〉 0. 05 ）. The rebleeding rate in one year increased as ICG - RI5 increasing,and it was higher in drug therapy group. Conclusion Total cholesterol, fibrinogen, ICG - R15, splenic thick were independent risk factors of EVB. The rebleeding rate of EVB in one year increased as ICG - R15 increasing. Compared with drug therapy, operation therapy can get lower re- bleeding rate in one year. So different liver reserve function and treatment methods closely related to the prognosis of EVB. They were im- portant indicators of prognosis evaluating.

关 键 词：肝储备功能 食管静脉曲张破裂出血 危险因素 15分钟滞留率 再出血率 

分 类 号：R571[医药卫生—消化系统]