乙肝肝硬化患者食管胃底静脉曲张破裂出血的危险因素分析  

Analysis of risk factors for esophagogastric varices bleeding in patients with hepatitis B cirrhosis

作　　者：周佳美[1] 班志超 李艳 张晓娟[1] 张咏华[1] 王明蕾[1] Zhou Jiamei;Ban Zhichao;LI Yan;Zhang Xiaojuan;Zhang Yonghua;Wang Minglei(Department of Gastroenterology,The Second Central Hospital of Baoding,Zhuozhou,Hebei,072750,China)

机构地区：[1]保定市第二中心医院消化内科,河北涿州072750

出　　处：《当代医学》2019年第1期125-127,共3页Contemporary Medicine

基　　金：保定市科技支撑计划项目(17ZF132)

摘　　要：目的筛选乙肝肝硬化患者食管胃底静脉曲张破裂出血的危险因素。方法选取乙肝肝硬化患者90例,食管胃底静脉曲张破裂出血患者37例为出血组,非出血组为53例,分别统计其临床资料包括年龄、性别、谷丙转氨酶(ALT)、谷草转氨酶(AST)、血小板(platelet count,PLT)、血清总胆红素(TBIL)、血清白蛋白(serum albumin,ALB)、凝血酶原活动度(PTA)、门静脉直径、脾脏直径、腹水、HCC、碱性磷酸酶(ALP)、白细胞(WBC)、血钙(Ca)15个指标首先进行单因素分析,差异有统计学意义的指标进行Logistic回归分析得出乙肝肝硬化患者并发食管胃底静脉曲张破裂出血的独立危险因素。结果单因素分析发现年龄,有无腹水、谷丙转氨酶ALT、谷草转氨酶AST、总胆红素(TBIL)、血钙、血小板(PLT)、脾脏直径和碱性磷酸酶ALP为危险因素,两组比较差异有统计学意义(P<0.05)。进一步行多因素Logistic回归分析,发现年龄、血钙、谷草转氨酶和总胆红素与乙肝肝硬化食管胃底静脉曲张破裂出血的发生呈负相关,其回归系数分别为-1.205、-1.533、-2.583和-1.733,相对危险度OR值分别为0.300、0.212、0.076和0.177,年龄、血钙、AST和TBIL是乙肝肝硬化食管胃底静脉曲张破裂出血的独立危险因素,并进行ROC曲线发现AUC值分别为0.710,0.687,0.784,0.685。结论年龄、血钙、谷草转氨酶和总胆红素是肝硬化患者发生食管静脉曲张破裂出血的独立危险因素,其中谷草转氨酶的曲线下面积值最大,其灵敏度和特异度相对较高。Objective To screen the risk factors of esophageal and gastric varices bleeding in patients with hepatitis B cirrhosis.Methods 90 patients with hepatitis B cirrhosis,37 patients with esophageal varices bleeding,including bleeding group,53 patients with non-bleeding group,their general data including age,gender,alanine aminotransferase(ALT),and grass Transaminase(AST),platelet count(PLT),serum total bilirubin(TBIL),serum albumin(ALB),prothrombin activity(PTA),portal diameter,spleen diameter Ascites,HCC,alkaline phosphatase(ALP),white blood cells(WBC),and serum calcium were first analyzed by one-way analysis of variance,and logistic regression analysis was performed on the statistically significant(P<0.05)index,and the independent risk factors for esophageal varices bleeding in patients with hepatitis B cirrhosis were obtained.Results Univariate analysis revealed:age,presence or absence of ascites,alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),blood calcium(blood Ca),platelet(PLT),spleen diameter and alkali Sex phosphatase(ALP)was a risk factor,and the difference was statistically significant(P<0.05).Further logistic regression analysis showed that age,serum calcium,aspartate aminotransferase and total bilirubin were negatively correlated with the occurrence of esophageal and gastric varices bleeding in hepatitis B cirrhosis,and the regression coefficients were-1.205,-1.533,-2.583 and-1.733,relative risk(OR values)were 0.300,0.212,0.076,and 0.177,respectively.Age,serum calcium,AST,and TBIL were independent risk factors for esophageal and gastric varices bleeding in patients with hepatitis B cirrhosis,and ROC curves were found for AUC.The values are 0.710,0.687,0.784,and 0.685,respectively.Conclusion Age,serum calcium,aspartate aminotransferase and total bilirubin are independent risk factors for esophageal varices bleeding in patients with liver cirrhosis.The area under the curve of aspartate aminotransferase is the largest,and its sensitivity and specificity are relatively high

关 键 词：乙肝肝硬化 食管胃底静脉曲张破裂出血 危险因素 

分 类 号：R575.2[医药卫生—消化系统] R512.62[医药卫生—内科学]