乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者临床特征及其危险因素分析  

Clinical features and risk factors of esophagogastric variceal bleeding in patients with hepatitis B liver cirrhosis

作　　者：江秋维 黄理[1] 姚朝光[1] Jiang Qiuwei;Huang Li;Yao Chaoguang(Department of Gastroenterology,Municipal Hospital,Affiliated to Youjiang Medical University For Nationalities,Hechi 547000,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]右江民族医学院附属河池市人民医院消化内科,广西壮族自治区河池市547000

出　　处：《实用肝脏病杂志》2021年第4期532-535,共4页Journal of Practical Hepatology

基　　金：河池市科技局科研计划项目(编号:2018CZ07081)。

摘　　要：目的分析乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血(EVB)患者的临床特征,并探讨乙型肝炎肝硬化发生EVB的危险因素。方法2018年6月~2020年6月我院收治的乙型肝炎肝硬化并发食管胃底静脉曲张(GOV)患者108例,当发生曲张静脉破裂出血时,给予内科止血治疗。收集临床资料,应用单因素和多因素Logistic回归模型分析确定乙型肝炎肝硬化发生EVB的独立危险因素。结果在108例乙型肝炎肝硬化并发GOV患者中,38例(35.2%)发生EVB,其中5例(13.2%)患者在发病72 h内死亡;单因素分析提示过度劳累与GOV患者发生EVB无显著的相关性(P>0.05),而饮食不当、服用非甾体类抗炎药、血小板计数(PLT)、凝血酶原时间(PT)、血清白蛋白(ALB)、门静脉内径、脾静脉内径、红色征、肝功能Child-Pugh分级和食管胃底静脉曲张程度与GOV患者发生EVB显著相关(P<0.05);多因素Logistic回归分析结果显示饮食不当[OR(95%CI)为2.2(1.3~3.7)]、门静脉内径增宽[OR(95%CI)为1.4(1.1~1.7)]、PT延长[OR(95%CI)为1.3(1.1~1.6)]、有红色征[OR(95%CI)为3.3(1.6~7.1)]、肝功能Child-Pugh C级[OR(95%CI)为3.9(1.7~9.0)]和重度食管胃底静脉曲张[OR(95%CI)为3.5(1.9~6.5)]是乙型肝炎肝硬化发生EVB的独立危险因素。结论乙型肝炎肝硬化并发GOV患者存在一些上消化道出血的原因,其中EVB是重要的致命原因。EVB发生的本身有一些危险因素,需要临床给予必要的一级和二级预防措施,以减少EVB的发生。Objective The aim of this study was to summarize the clinical features of patients with hepatitis B liver cirrhosis(LC)complicated by esophagogastric variceal bleeding(EVB),and to explore the risk factors of EVB.Methods The clinical data of 108 patients with hepatitis B LC complicated with gastroesophageal varices(GOV)were collected in our hospital between June 2018 and June 2020,and internal medicine was given when the EVB occurred.The clinical features of patients were summarized and the independent risk factors of EVB were evaluated by univariate and multivariate Logistic regression analysis.Results Among the 108 patients with hepatitis B LC and GOV,the EVB occurred in 38 cases(35.2%),and out of which,5 patients(13.2%)died within 72 hours after onset of bleeding;the univariate analysis indicated that overwork was not significantly related with EVB in patients with hepatitis B LC and GOV(P>0.05),while improper diet,taking non-steroidal anti-inflammatory agents,platelet(PLT)count,prothrombin time(PT),serum albumin(ALB),diameter of portal vein and splenic vein,red-color sign,Child-Pugh class of liver functions and GOV degrees were significantly correlated with EVB happening(P<0.05);the multivariate Logistic regression analysis showed that improper diet[OR(95%CI:2.2(1.3-3.7)],increased portal vein diameter[OR(95%CI:1.4(1.1-1.7)],prolonged PT[OR(95%CI:1.3(1.1-1.6)],red-color sign[OR(95%CI:3.3(1.6-7.1)],Child-Pugh class C[OR(95%CI:3.9(1.7-9.0)]and severe GOV[OR(95%CI:3.5(1.9-6.5)]were the independent risk factors of EVB in patients with LC.Conclusion The EVB is the improper cause of gastrointestinal bleeding in patients with hepatitis B-induced LC,and the common intriguing events should be dealt with early and appropriately in clinical practice to decrease the EVB occurrence.

关 键 词：肝硬化 食管胃底静脉曲张 曲张静脉破裂出血 危险因素 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]