肝硬化食管胃静脉曲张破裂出血相关危险因素分析  

The Analysis of Risk Factors in Esophageal Varices Bleeding of Cirrhosis Patients

作　　者：黄鹤[1] 伦伟健[1] 梁晓燕[1] 刘浏[1] 贾柳萍[1] 

机构地区：[1]南方医科大学附属南海医院消化内科,广东佛山528200

出　　处：《四川医学》2016年第3期320-323,共4页Sichuan Medical Journal

摘　　要：目的探讨肝硬化患者食管胃静脉曲张破裂出血的预测指标,为临床提供参考。方法收集2010年1月至2015年4月我院消化内科收治的的肝硬化合并食管胃静脉曲张破裂出血479例患者为出血组,另外选择同期收治的肝硬化未合并食管胃静脉曲张破裂出血的患者672例患者为对照组。对两组患者病历资料进行统计分析。结果两组患者年龄、性别、肝硬化病因相比差异无统计学意义(P>0.05),两组患者血清总胆红素、活化部分凝血酶原时间时间、合并门脉高压性胃病、合并消化性溃疡差异无统计学意义(P>0.05)。出血组肝功能Child-Pugh评分、食管静脉曲张分级重度率、中性粒细胞、门静脉主干内径、脾静脉主干内径、腹水比例、脾厚度、RC征比例均高于对照组,差异有统计学意义(P<0.05);出血组白蛋白、血小板计数、胆固醇低于对照组,差异有统计学意义(P<0.05)。Logisitc回归分析显示白蛋白(OR=0.67)、血小板计数(OR=0.74)为肝硬化并发食管胃静脉曲张破裂出血的保护因素,门静脉内径(OR=4.68)、脾厚度(OR=3.92)、红色征(OR=2.26)、食管静脉曲张分级(OR=3.71)为肝硬化并发食管胃静脉曲张破裂出血的危险因素。结论门静脉内径、脾厚度、白蛋白、血小板计数、红色征、食管静脉曲张分级为肝硬化并发食管胃静脉曲张破裂出血的相关因素,可以提示出血风险。Objective To discuss predictor of esophageal varices bleeding of cirrhosis patients in order to provide refer- ence for clinic. Methods 479 patients treated in our hospital with cirrhosis united esophageal varices bleeding from 2010.01 to 2015.04 were collected as bleeding group and 672 patients treated at the same time with cirrhosis but no esophageal varices bleed- ing as control group. Analyze the medical data of the two groups statistically. Results The difference of ages, sex and cases of dis- ease has no Statistic significance（P 〉 0.05 ）, the serum total bilirubin;activated partial prothrombin time（ APPT）, portal hyperten- sive gastric disease and combined peptic ulcer has no statistic significance （P 〉 0.05 ）. Liver function child-pigh score, grading of esophageal varices, medium granular cell, main diameter of portal vein, main diameter of splenic vein, ascites ratio, spleen thickness and RC sign ratio of the bleeding group are higher than the control group and the differences have statistic significance（ P 〈 0.05 ） ; plasma protein,platelet count and cholesterin are lower than the bleeding group and the differences have statistic significance（P 〈 0.05 ）. Logisitc regression analysis （ OR = 0.67） and platelet count （ OR = 0.74） are protection factors of esophageal and gastric vat- ices bleeding in patients with cirrhosis, inner diameter of portal vein （ OR -- 4.68 ）, spleen thickness （ OR = 3.92 ）, red-color sign （ OR = 2.26） and grading of esophageal varices （ OR = 3.71 ） are risk factors of esophageal and gastric varices bleeding in patients with cirrhosis. Conclusion Inner diameter of portal vein, spleen thickness, plasma protein, platelet count, red-color sign and grad- ing of esophageal varices are correlative factors of esophageal and gastric varices bleeding in patients with cirrhosis which can point out bleeding risks.

关 键 词：肝硬化 食管胃静脉曲张破裂出血 风险 预测 

分 类 号：R575.2[医药卫生—消化系统]