小肠血管畸形患者再出血危险因素及沙利度胺干预治疗  

Re-bleeding events in patients with small intestinal vascular malformation:Risk factors and effect of treatment with thalidomide

作　　者：王亚[1] 张金平[1] 牛颖[1] 李建生[1] Ya Wang Jin-Ping Zhang Ying Niu Jian-Sheng Li(Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, He＇nan Province, Chin)

机构地区：[1]郑州大学第一附属医院消化内科,河南省郑州市450052

出　　处：《世界华人消化杂志》2017年第6期552-559,共8页World Chinese Journal of Digestology

摘　　要：目的探讨小肠血管畸形患者再出血率及相关危险因素,指导临床对此类患者的管理,同时探讨沙利度胺对小肠血管畸形患者再出血率的影响.方法选取郑州大学第一附属医院2012-01/2014-12行胶囊内镜(capsule endoscopy,CE)及小肠镜检查的消化道出血患者,排除其中非小肠血管畸形患者,通过查阅病历、门诊随访及打电话随访的方式观察小肠血管畸形患者(156例)的再出血率,分析再出血相关危险因素及应用沙利度胺患者(70例)和未应用沙利度胺患者(86例)再出血率有无差异.结果共纳入小肠血管畸形患者156例并全部完成随访,平均随访时间10.78 mo±7.64 mo,再出血率为46.15%(72/156),其中高血压病史(HR=1.994,95%CI:1.236-3.125,P=0.005)、畸形血管数(≥3)(HR=1.644,95%CI:1.002-2.703,P=0.049)、肝硬化病史(HR=2.116,95%CI:1.063-4.212,P=0.033)是小肠血管畸形患者再出血的独立危险因素,而应用沙利度胺治疗是小肠血管畸形患者再出血保护性因素(HR=0.497,95%CI:0.303-0.816,P=0.006).CE及小肠镜检查后治疗患者再出血率比较,应用沙利度胺患者再出血率比未应用沙利度胺患者再出血率低(35.71%vs 54.65%),差异具有统计学意义(P<0.05).结论小肠血管畸形患者再出血率较高,应该在内镜检查后密切随访,尤其是合并高血压、肝硬化、血管畸形数目(≥3)的患者,建议在2年内复查CE或电子小肠镜.无相关禁忌证的患者在药物治疗方面可给予沙利度胺应用,可以降低其再出血率.AIM To investigate the risk factors for re-bleeding events in patients with small intestinal vascular malformation and assess the influence of thalidomide on the re-bleeding rate.METHODS This study involved patients with gastrointestinal bleeding referred to the First Affiliated Hospital of Zhengzhou University for capsule endoscopy（CE） and enteroscopy between January 2012 and December 2014.Only patients with small intestinal vascular malformation were included in the study.Follow-up data were obtained through medical records review,telephone interviews or follow-up clinic visits to identify the risk factors associated with re-bleeding.Based on the follow-up data,the re-bleeding rate was compared between patients who had been treated with thalidomide and those who had not.RESULTS A total of 156 patients were included in the study,and all of them completed the followup,with a mean follow-up duration of 10.78 ±7.64 mo.Multiple regression analysis identified that presence of hypertension（HR = 1.994,95%CI：1.236-3.125,P = 0.005）,multiple lesions（ 3）（HR = 1.644,95%CI：1.002-2.703,P = 0.049） and liver cirrhosis（HR = 2.116,95%CI：1.063-4.212,P = 0.033） were significant independent predictors of re-bleeding,while treatment with thalidomide was a protecting factor（HR = 0.497,95%CI：0.303-0.816,P =0.006）.The cumulative re-bleeding rates in patients who were treated with thalidomide and those who were not were 35.71%and54.65%,respectively,and the difference reached statistical significance（P〈0.05）.CONCLUSION The re-bleeding rate in patients with small bowel vascular malformation is relatively high,especially those with hypertension,multiple lesions（ 3） and liver cirrhosis.Repeated CE or enteroscopy is recommended for those patients with risk factors for re-bleeding within 2 years.Treatment with thalidomide for patients without contraindication can reduce the re-bleeding rate.

关 键 词：小肠血管畸形 胶囊内镜 小肠镜 再出血 沙利度胺 

分 类 号：R574.5[医药卫生—消化系统]