糖尿病对肝硬化食管静脉曲张内镜治疗后再出血影响的临床研究  

Effects of diabetes on rebleeding after endoscopic treatment in liver cirrhosis patients with esophageal varices

作　　者：王曦 梅雪灿 张娜[1] 孔德润[1] Wang Xi;Mei Xuecan;Zhang Na;Kong Derun(Department of Gastroenterology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院消化内科,合肥230022

出　　处：《中华消化内镜杂志》2020年第1期33-37,共5页Chinese Journal of Digestive Endoscopy

基　　金：安徽省转化医学研究院科研基金(2017zhyx18);安徽省科技厅2018年度重点研究与开发计划项目(1804h08020260)。

摘　　要：目的探讨合并糖尿病是否影响肝硬化食管静脉曲张患者内镜治疗后的再出血。方法2015年6月至2018年3月,因肝硬化食管静脉曲张破裂出血在安徽医科大学第一附属医院接受内镜下静脉曲张套扎术或内镜下硬化剂注射术初次治疗的207例病例纳入回顾性分析,以术后6个月作为观察结束点统计再出血情况,根据有无出血分为出血组(n=54)和未出血组(n=153),对于可能导致术后再出血的影响因素先行单因素分析,发现差异性后再行Logistic回归分析。结果单因素分析发现,性别构成、年龄、有无门静脉血栓、有无吸烟史、有无饮酒史(P=0.05)、有无高血压、血小板计数、总胆红素水平、白蛋白水平、谷丙转氨酶水平、凝血酶原时间、食管静脉曲张程度构成、手术方式构成在出血组和未出血组间差异均无统计学意义(P均≥0.05),是否合并糖尿病、血红蛋白水平、血糖水平、腹水程度构成、肝功能分级构成在出血组和未出血组间差异均有统计学意义(P均<0.05)。将合并糖尿病(是/否)、血红蛋白水平、血糖水平、腹水程度(无-轻度/中-重度)、肝功能Child-Pugh分级(A级/B-C级)以及饮酒史(有/无)纳入多因素分析,结果显示合并糖尿病是肝硬化食管静脉曲张内镜治疗后再出血的独立危险因素(P=0.008,OR=2.973,95%CI:1.322~6.689)。结论合并糖尿病的肝硬化食管静脉曲张患者内镜治疗后易发生再出血。ObjectiveTo investigate whether combined diabetes affects rebleeding after endoscopic treatment in cirrhosis patients with esophageal varices.MethodsA total of 207 liver cirrhosis cases with esophageal varices bleeding who underwent initial treatment of endoscopic variced ligation or endoscopic injection sclerotherapy in the First Affiliated Hospital of Anhui Medical University from June 2015 to March 2018 were included in the retrospective study.The cases were divided into bleeding group(n=54)and non-bleeding group(n=153)according to the presence or absence of rebleeding within 6 months after treatment.The influencing factors on postoperative bleeding were analyzed by univariate analysis and logistic regession analysis.ResultsUnivariate analysis showed that gender composition,age,presence or absence of portal vein thrombosis,smoking history,drinking history(P=0.05),hypertension,platelet count,total bilirubin level,albumin level,alanine aminotransferase level,prothrombin time,degree of esophageal varices,and surgical methods were not significantly different(all P≥0.05)between the bleeding group and the non-bleeding group.There were significant differences in diabetes,hemoglobin level,blood glucose level,ascites composition,and liver function grade composition between the two groups(all P<0.05).Combined diabetes(yes/no),hemoglobin levels,blood glucose levels,ascites(none-mild/medium-severe),liver function Child-Pugh classification(Grade A/B-C),and history of drinking(yes/no)were included in multivariate analysis,and results showed that diabetes was an independent risk factor for rebleeding after endoscopic treatment of esophageal varices(P=0.008,OR=2.973,95%CI:1.322-6.689).ConclusionAfter endoscopic treatment of liver cirrhosis patients with esophageal varices,rebleeding is more likely to occur in patients complicated with diabetes.

关 键 词：糖尿病 肝硬化 食管静脉曲张 内镜下静脉曲张套扎术 内镜下硬化剂注射术 再出血 

分 类 号：R575[医药卫生—消化系统] R587[医药卫生—内科学]