乙型肝炎肝硬化患者发生食管胃静脉曲张破裂出血的危险因素分析  

Risk factors of esophageal variceal bleeding in patients with hepatitis B cirrhosis

作　　者：王宛明[1] WANG Wan-ming(Department of Gastroenterology, The People＇ s Hospital of Puyang, 457000, Chin)

机构地区：[1]濮阳市人民医院消化科,457000

出　　处：《传染病信息》2017年第3期164-167,共4页Infectious Disease Information

摘　　要：目的探索乙型肝炎肝硬化患者发生食管胃静脉曲张破裂出血的危险因素。方法选取2014年10月—2016年6月因乙型肝炎肝硬化并发食管胃静脉曲张来我院进行治疗的患者165例,根据就诊当天是否发生破裂出血分为出血组和非出血组,分析该类患者破裂出血的危险因素。结果单因素分析结果显示:2组患者在年龄、性别和WBC计数方面的差异无统计学意义(P>0.05),出血组患者HGB、PT明显高于非出血组,而PLT明显低于非出血组,差异有统计学意义(P<0.05);出血组患者中肝功能Child-Pugh评分C级患者、重度食管胃静脉曲张患者及中重度腹水患者明显多于未出血组,2组患者在肝功能Child-Pugh评分、食管胃静脉曲张和腹水严重程度上的差异有统计学意义(P<0.05)。多因素分析结果显示:肝功能Child-Pugh评分、PLT、腹水、门静脉内径和感染是发生破裂出血的危险因素,其中腹水严重程度是最主要的独立危险因素。结论肝功能Child-Pugh分级较低、PLT较低、腹水较严重、门静脉内径较大和出现感染是乙型肝炎肝硬化患者发生食管胃静脉曲张破裂出血的危险因素,临床上须尽早进行对症治疗,预防破裂出血的发生。Objective To explore the risk factors of esophageal and gastric varices bleeding in patients with hepatitis B cirrhosis. Methods A total of 165 patients with hepatitis B cirrhosis esophageal varices in our hospital from October 2014 to June 2016 were included in this study. According to the presence of bleeding at the visit day, patients were divided into bleeding group and non-bleeding group. The risk factor of rupture bleeding was analyzed. Results One-way analysis of variance showed that there were no significant differences in the age, gender and white blood cells between the 2 groups （P 〉 0.05）. HGB and PT levels in the bleeding group were obviously higher than those in non-bleeding group, while PLT level was significantly lower （P 〈 0.05）. Patients with liver function Chiht- Pugh C level, with severe stomach esophagus varicosity, and with moderately severe ascites in the bleeding group wel~ significantly more than those in non-bleeding group, with significant differences in Child-Pugh score, esophageal and gastric varices, and ascites （P 〈 0.05）. Muhi-factor analysis showed that liver function Child-Pugh score, platelet count, ascites, portal vein diameter and infection were risk thctors for bleeding. Among them ascites was the most important independent risk factor. Conclusions Low Child-Pugh classification of liver function, low platelet count, severe ascites, large portal vein diameter and infection are high risk factors of rupture hemorrhage in patients with hepatitis B cirrhosis, esophageal and gastric varices. Clinical treatment should be given as soon as possible to prevent rupture bleeding.

关 键 词：乙型肝炎肝硬化 食管胃静脉曲张 破裂出血 危险因素 

分 类 号：R575.2[医药卫生—消化系统] R571.3[医药卫生—内科学]