肝硬化患者静脉曲张出血的临床和内镜特点分析  

Clinical characteristics and endoscopic findings in patients with cirrhotic upper gastrointestinalvariceal bleeding

作　　者：张媛媛[1] 陈国栋[1] 王智峰[1] 刘心怡 史晨辰[1] 刘玉兰[1] 

机构地区：[1]北京大学人民医院消化内科,100044

出　　处：《中华普通外科杂志》2018年第2期134-137,共4页Chinese Journal of General Surgery

摘　　要：目的探讨肝硬化静脉曲张出血患者的临床和内镜特点，并分析内镜治疗后再出血的危险因素。方法回顾性分析2010年5月至2017年5月北京大学人民医院收治的383例肝硬化静脉曲张出血患者的临床和内镜资料，根据是否出现内镜治疗后再出血分为再出血组和对照组，总结其临床特点和内镜下特点，分析引起再出血的危险因素。结果383例内镜治疗后发生再出血共34例，发生率为8．88％；单因素分析显示高龄、男性、肝硬化病因、Child评分、凝血酶原时间、血小板减少、重度静脉曲张、静脉曲张红色征阳性、门静脉增宽、门静脉血栓是静脉曲张内镜治疗后再次出血的危险因素（P〈0．05）；非条件多因素Logistic分析结果显示男性（P=0．036；OR=2．975）、自身免疫性肝病（P=0．047；OR=2．512）、Child评分（P=0．026，伽=1．852）、凝血酶原时间（P=0．017；OR=3．746）、门静脉血栓（P=0．027；OR=1．954）、静脉曲张红色征阳性（P=0．016：OR=4．013）是静脉曲张出血内镜治疗后再出血的独立危险因素（P〈0．05）。结论肝硬化患者静脉曲张出血经内镜治疗后再出血较为常见。男性、自身免疫性肝病、Child评分、凝血酶原时间、门静脉血栓、静脉曲张红色征阳性等是发生再出血的独立危险因素。Objective To analyze the clinical characteristics and endoscopic findings in patients with cirrhosis and upper gastrointestinal variceal bleeding （UGIB） and to evaluate the risk factors of rebleeding after endoscopic therapy. Method Between May 2010 and May 2017, 383 patients who diagnosed with cirrhosis and UGIB were enrolled. Results The incidence of rebleeding was 8.88% （ n = 34 ）. In the univariate analysis, advanced age （ P = 0. 362, OR = 0. 662 ）, male （ P = 0. 036, OR = 2. 975 ）, cause of cirrhosis （ P = O. 047, OR = 2. 512 ） , Child-Pugh scores （ P = O. 026, OR = 1. 852 ）, prothrombin time （ P = 0. 017, OR = 3. 746 ）, thrombocytopenia （ P = O. 445, OR = 0. 577 ）, severe varices （ P = 0. 314, OR = 0. 745 ）, red color sign （ P = 0. 016, OR = 4. 013 ）, portal vein diameter （ P = 0. 365, OR = 1. 026 ）, portal thrombosis （P = 0. 027, OR = 1. 954） were risk factors for rebleeding following endoscopic therapy. In the non-condition multivariate logistic regression analysis, male （ P = 0. 036, OR = 2. 975 ） , antoimmune liver disease （P = 0. 047, OR = 2. 512 ）, Child-Pugh scores （ P = 0. 026, OR = 1. 852）, prothrombin time （P =0. 017 OR =3. 746）, red color sign（P =0. 016, OR =4. 013）, portal thrombosis （P =0. 027, OR = 1. 954 ） were independent risk factors for rebleeding following endoscopic therapy. Conclusions Esophagogastric variceal rebleeding is common after a successful initial endoscopic therapy. Independent risk factors for rebleeding are male, autoimmune liver disease, elevated Child-Pugh scores, prolonged thrombin time, portal vein thrombosis and red color sign.

关 键 词：肝硬化 胃肠出血 食管和胃静脉曲张 

分 类 号：R575.2[医药卫生—消化系统]