肝硬化食管静脉曲张破裂出血的临床特点与危险因素分析  

Clinical features and risk factors of esophageal variceal bleeding in patients with cirrhosis

作　　者：唐学良 张晖 凌明强 Tang Xueliang;Zhang Hui;Ling Mingqiang(Emergency Room,The Second People's Hospital of Panyu District,Guangzhou 511430,China;Department of Gastroenterology,Hexian Memorial Hospital,Panyu District,Guangzhou 511400,China)

机构地区：[1]广州市番禺区第二人民医院急诊科,广州511430 [2]广州市番禺区何贤纪念医院消化内科,广州511400

出　　处：《国际医药卫生导报》2022年第19期2753-2757,共5页International Medicine and Health Guidance News

基　　金：广州市番禺区科技计划项目(2021-Z04-025)。

摘　　要：目的分析肝硬化门脉高压食管胃静脉曲张破裂出血(EVB)的临床特点,探讨其相关危险因素。方法2019年1月至2021年12月在广州市番禺区第二人民医院与广州市番禺区何贤纪念医院收治的共302例肝硬化食管胃静脉曲张(GOV)患者为调查对象,男210例,女92例,年龄(51.52±7.97)岁。按是否发生破裂出血分为研究组(EVB,118例)和对照组(GOV非出血组,184例),统计学方法采用t检验、χ^(2)检验。结果研究组和对照组在活化部分凝血酶原时间(ATPP)、是否有肝性脑病、是否有肝肾综合征和Child-Pugh分级构成方面差异均无统计学意义(均P>0.05);在凝血酶原时间(PT)、血小板计数(PLT)、总胆红素、白蛋白(ALB)、脾静脉主干内径、门静脉主干内径、脾厚度、有无腹水、有无红色征、有无门静脉血栓、食管静脉曲张程度构成方面差异均有统计学意义(均P<0.05)。logistic多因素回归分析结果显示,红色征(OR=5.606,95%CI 1.615~20.650)、食管静脉曲张程度(OR=3.337,95%CI 1.057~15.079)、门静脉主干内径(OR=1.703,95%CI 1.008~4.340)、脾厚度(OR=1.564,95%CI 1.022~3.563)、PT(OR=1.043,95%CI 1.004~1.082)是EVB的独立危险因素(均P<0.05),PLT(OR=0.737,95%CI 0.291~0.833)、ALB(OR=0.663,95%CI 0.172~0.878)是EVB的保护因素(均P<0.05)。结论红色征、食管静脉曲张程度、门静脉内径、脾厚度、PT是发生EVB的危险因素,提高PLT、ALB水平可减少EVB的发生。Objective To analyze the clinical features of cirrhosis portal hypertension esophageal variceal bleeding(EVB)and to explore its associated risk factors.Methods Three hundred and two patients with cirrhosis and gastroesophageal varices(GOV)admitted to The Second People's Hospital of Panyu District and Hexian Memorial Hospital from January 2019 to December 2021 were selected as the investigation objects,including 210 males and 92 females,and they were(51.52±7.97)years old.They were divided into a study group(EVB,118 cases)and a control group(GOV non-bleeding group,184 cases)according to whether rupture and bleeding occurred.t andχ^(2) tests were applied.Results There were no statistical differences the in activated partial thromboplastin time,whether there was hepatic encephalopathy,whether there was hepatorenal syndrome,and the composition of Child-Pugh grading between the study group and the control group(all P>0.05),and were in prothrombin time(PT),platelets(PLT),total bilirubin,albumin(ALB),spleen vein trunk inner diameter,portal vein trunk inner diameter,spleen thickness,presence or absence of ascites,presence or absence of red signs,presence or absence of portal vein thrombosis,and composition of varicose veins of the esophagus(all P<0.01).Logistic multivariate regression analysis showed that the red signs(OR=5.606,95%CI 1.615-20.650),the degree of esophageal variceality(OR=3.337,95%CI 1.057-15.079),the portal vein inner diameter(OR=1.703,95%CI 1.008-4.340),spleen thickness(OR=1.564,95%CI 1.022-3.563),and PT(OR=1.043,95%CI 1.004-1.082)were independent risk factors affecting EVB(all P<0.05),and PLT(OR=0.737,95%CI=0.291-0.833)and ALB(OR=0.663,95%CI=0.172-0.878)were the protective factors for EVB(both P<0.05).Conclusions Red signs,degree of esophageal varices,portal vein diameter,spleen thickness,and PT were risk factors for the development of EVB,and increase of PLT and ALB can reduce the occurrence of EVB.

关 键 词：肝硬化 食管胃静脉曲张 曲张静脉破裂出血 临床特征 危险因素 

分 类 号：R575.2[医药卫生—消化系统]