肝硬化食管胃底静脉曲张破裂出血伴缺血性肝炎的危险因素分析  

Analysis on risk factors of ischemic hepatitis in patients with liver cirrhosis complicated with esophageal and gastric varices bleeding

作　　者：张昕 吕丹[1] 刘丹阳[1] ZHANG Xin;LV Dan;LIU Dan-yang(Department of Internal Medicine,the Sixth People's Hospital of Shenyang,Shenyang 110006,China)

机构地区：[1]沈阳市第六人民医院内科,辽宁省110006

出　　处：《肝脏》2022年第1期47-50,共4页Chinese Hepatology

摘　　要：目的探讨肝硬化食管胃底静脉曲张破裂出血(esophageal and gastric varices bleeding,EGVB)继发缺血性肝炎的相关危险因素。方法回顾性分析2020年1月至8月沈阳市第六人民医院102例EGVB患者的临床资料,根据是否出现缺血性肝炎分为观察组和对照组。对一般资料、实验室指标、辅助检查结果、临床情况进行单因素分析,二元Logistic多因素分析EGVB后继发缺血性肝炎的相关危险因素。结果102例EGVB患者中,14例伴有缺血性肝炎(转氨酶升高>10倍正常值上限)纳入观察组,余88例纳入对照组。观察组死亡5例,是对照组的4.46倍。观察组ALT、AST峰值多出现在入院第2日,依次为791.00(555.25,1657.5)U/L、2541.50(1480.50,4594.00)U/L。单因素分析结果显示,观察组和对照组ALT、AST、γ-GGT、LDH、TBil、白细胞、血小板计数、脾长、脾门静脉、门脉主干内径、门静脉血栓、死亡、合并肝性脑病、合并脓毒症、Child-Pugh评分、腹腔积液等指标,差异有统计学意义(均P<0.05);二元logistic多因素分析显示,伴有肝癌(P<0.01)、白细胞计数(P=0.014)、γ-GGT(P=0.025)、Child-Pugh分级(P=0.050)与EGVB后出现缺血性肝损伤具有显著相关性。结论伴有肝癌、白细胞计数、肝硬化Child-Pugh分级是EGVB合并缺血性肝炎的危险因素。Objective To investigate the incidence rate,mortality and risk factors of ischemic hepatitis secondary to esophageal and gastric varices bleeding(EGVB).Methods The clinical data of 102 patients with EGVB admitted to our hospital from January to August 2020 were retrospectively analyzed.The patients were divided into observation group and control group according to the occurrence of ischemic hepatitis.The general data,laboratory results,auxiliary examination results and clinical situation were analyzed by univariate analysis,and the statistically significant indexes were selected(P<0.05).The significant indexes were analyzed by multivariate logistic regression analysis,the incidence rate,mortality rate and risk factors of ischemic hepatitis secondary to EGVB were evaluated.Results Among 102 patients with EGVB,14 of them complicated with ischemic hepatitis(transaminase level>10 times the upper limit of normal value)were included in observation group,and the remaining 88 patients were included in control group.The mortality of observation group was 35.7%,which was 4.46 times higher than that of control group.The peak values of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in observation group mostly appeared on the second day after admission,which were 791.00(555.25,1657.5)U/L and 2541.50(1480.50,4594.00)U/L respectively.Univariate analysis showed that there were significant differences in ALT,AST,gamma-glutamyltranspeptidase(GGT),lactate dehydrogenase(LDH),total bilirubin(TBIL),white blood cell(WBC),platelet count,spleen length,splenic portal vein,portal vein trunk diameter,portal vein thrombosis,mortality,complicated with hepatic encephalopathy,complicated with sepsis,Child-Pugh score and ascites situation between the 2 groups(all<0.05).Multivariate logistic regression analysis showed that liver cancer(P=0.000),white blood cell count(P=0.014),GGT(P=025),Child-Pugh grade(P=0.050)were significantly correlated with the incidence of ischemic hepatitis secondary to EGVB.Conclusion The incidence rate o

关 键 词：缺血性肝炎 缺氧性肝炎 肝硬化 食管胃静脉曲张破裂出血 

分 类 号：R57[医药卫生—消化系统]