肝硬化急性食管静脉曲张破裂出血住院患者的短期预后因素  

Short-term prognostic factors in hospitalized cirrhotic patients with acute esophageal variceal bleeding

作　　者：张海平[1] 林军[1] 

机构地区：[1]武汉大学中南医院消化内科,湖北省武汉市430071

出　　处：《世界华人消化杂志》2015年第19期3152-3156,共5页World Chinese Journal of Digestology

摘　　要：目的:分析影响肝硬化食管静脉曲张破裂出血(esophageal variceal bleeding,EVB)住院患者短期预后的因素.方法:回顾性分析146例肝硬化EVB住院患者的临床资料,其中住院死亡患者11例,住院生存患者135例.通过单因素和多因素Cox回归分析找出肝硬化EVB住院患者的短期预后因素;对影响预后的分级变量作KaplanM e i e r生存分析,分析不同层次变量对预后的影响.结果:单因素Cox回归分析显示年龄、白细胞计数增高、高胆红素血症、凝血酶原时间延长、凝血酶原活动度下降、低钠血症、肝性脑病、Child-Pugh分级、ChildP u g h评分是E V B死亡的危险因素,使用抗生素、内镜下治疗是E V B死亡的保护性因素.多因素Cox回归分析显示年龄(RR=1.055,95%C I:1.010-1.103,P=0.017),白细胞计数(RR=1.352,95%CI:1.073-1.704,P=0.011),C h i l d-P u g h分级(R R=4.822,95%C I:1.465-15.873,P=0.010)是肝硬化EVB住院患者死亡的危险因素;使用抗生素(RR=0.056,95%CI:0.012-0.264,P=0.000)是肝硬化EVB住院患者死亡的保护因素.K a p l a n-M e i e r生存分析显示肝功能C h i l dP u g h分级越高,患者住院生存时间越短、生存比例越低(χ2=16.651,P<0.0001);未使用抗生素的患者比使用抗生素的患者生存时间更短、生存比例更低(χ2=17.135,P<0.0001).结论:年龄、白细胞计数、Child-Pugh分级、使用抗生素是肝硬化EVB住院患者的短期预后因素.AIM：To analyze short-term prognostic factors in hospitalized cirrhotic patients with acute esophageal variceal bleeding（EVB）.METHODS：The clinical data for 146 hospitalized EVB patients with liver cirrhosis were analyzed retrospectively.Of these patients,135 survived in hospital,and 11 died.Univariate and multivariate Cox regression analyses were performed to identify short-term prognostic factors for acute EVB in these patients.Kaplan-Meier survival analysis was performed to evaluate the impact of different variables on prognosis.RESULTS：Univariate Cox regression analysis showed that age,increased white blood cell count,hyperbilirubinemia,increased prothrombin time,decreased prothrombin time activity,hyponatremia,hepatic encephalopathy,Child-Pugh grade and Child-Pugh score were risk factors for prognosis of EVB,while antibiotic treatment and endoscopic treatment were protective factors.Multivariate Cox regression analysis showed that age（RR =1.055,95%CI：1.010-1.103,P = 0.017）,white blood cell count（RR = 1.352,95%CI：1.073-1.704,P = 0.011）,and Child-Pugh grade（RR = 4.822,95%CI：1.465-15.873,P = 0.010） were risk factors for prognosis in cirrhotic patients with EVB,while antibiotic treatment（RR = 0.056,95%CI：0.012-0.264,P = 0.000） was a protective factor.Kaplan-Meier survival analysis showed that higher Child-Pugh grade was associated with shorter survival time and lower survival ratio（χ~2 = 16.651,P 0.0001）,and patients without antibiotic treatment had shorter survival time and lower survival ratio than patients with antibiotic treatment（χ~2 = 17.135,P 0.0001）.CONCLUSION：Age,white blood cell count,Child-Pugh grade and antibiotic treatment are short-term prognostic factors in hospitalized cirrhotic patients with acute EVB.

关 键 词：肝硬化 食管静脉曲张破裂出血 短期预后 

分 类 号：R575.2[医药卫生—消化系统]