肝硬化患者上消化道出血的危险因素分析  

Analysis of the risk factors for upper gastrointestinal bleeding in the patients with cirrhosis

作　　者：王茜[1] 薛莹 冯雪 程雪 石小枫[1] WANG Xi;XUE Ying;FENG Xue;CHENG Xue;SHI Xiaofeng(Department of Infectious Diseases,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China;Department of Infectious Diseases,Yunnan First People’s Hospital,Kunming,Yunnan 650100,China;Department of Rehabilitation,Wuhan First Hospital,Wuhan,Hubei 430030,China)

机构地区：[1]重庆医科大学附属第二医院感染科,400010 [2]云南省第一人民医院感染科,昆明650100 [3]湖北省武汉市第一医院康复科,430030

出　　处：《重庆医学》2022年第17期2926-2931,共6页Chongqing medicine

基　　金：国家自然科学基金项目(81270503);重庆市卫生局2009年度医学科研计划项目(2009-2-186)。

摘　　要：目的以非创伤性检查探讨肝硬化患者上消化道出血的危险因素。方法选取2010-2021年重庆医科大学附属第二医院明确诊断的414例肝硬化患者为研究对象,根据是否出血分为出血组(91例)和未出血组(323例),再将未出血组按照胃镜下静脉曲张程度分为高出血风险组(107例)和低出血风险组(216例)。收集患者的生化指标,进行单因素及多因素分析。结果出血组与未出血组凝血酶原活性度(PTA)、国际标准化比值(INR)、凝血酶原时间(PT)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、清蛋白(ALB)、γ-谷氨酰胺转移酶(γ-GT)、碱性磷酸酶(ALP)、总胆红素(TBil)、胆碱酯酶(CHE)、甲胎蛋白(AFP)、中性粒细胞(Neu)比较,差异有统计学意义(P<0.05),多因素logistic分析显示CHE升高是肝硬化患者发生上消化道出血的保护因素,Neu升高则是危险因素(P<0.05)。高出血风险组与低出血风险组AFP、白细胞计数(WBC)、血小板计数(PLT)、Neu、降钙素原(PCT)比较,差异有统计学意义(P<0.05),多因素logistic分析显示以上因素均不是胃镜下出血风险的影响因素(P>0.05)。结论CHE降低为肝硬化患者发生上消化道出血的危险因素。Objective To investigate the risk factors of upper gastrointestinal bleeding in the patients with cirrhosis by non-traumatic examination.Methods A total of 497 patients with cirrhosis confirmed in the Second Affiliated Hospital of Chongqing Medical University from 2010 to 2021 were selected.The patients with cirrhosis were divided into the bleeding group and the non-bleeding group according to whether bleeding or not.The bleeding group was divided into the high-risk group and the low-risk group according to the results of gastroscopy.Biochemical indicators of the above patients were collected for univariate and multivariate analysis.Results Comparisons between the bleeding group and the non-bleeding group of prothrombin activity(PTA),international standardized ratio(INR),prothrombin time(PT),alanine aminotransferase(ALT),aspartate aminotransferase(AST),serum albumin(ALB),γ-glutamine transferase(γ-GT),alkaline phosphatase(ALP),total bilirubin(TBil),cholinesterase(CHE),alpha-fetoprotein(AFP)and neutrophils(Neu)were statistically different(P<0.05).Multivariate logistic analysis showed that the increase of CHE was a protective factor for upper gastrointestinal bleeding in the patients with cirrhosis,while the increase of Neu was a risk factor(P<0.05).There were significant differences in the AFP,white blood cell count(WBC),platelet count(PLT),Neu and procalcitonin(PCT)between the high-risk group and the low-risk group(P<0.05).Multivariate logistic analysis showed that the above factors were not the influencing factors of gastroscopic bleeding risk.Conclusion The decrease of CHE is a risk factor for upper gastrointestinal bleeding in the patients with cirrhosis.

关 键 词：肝硬化 门静脉高压 食管静脉曲张 出血 危险因素 肝功能 凝血 

分 类 号：R575.2[医药卫生—消化系统]