慢加急性肝衰竭急性静脉曲张出血的危险因素及预后分析  

Risk factors for acute variceal bleeding in acute-on-chronic liver failure and its influence on prognosis

作　　者：刘婉姝 申力军 翟庆慧 辛绍杰 游绍莉 LIU Wanshu;SHEN Lijun;ZHAI Qinghui;XIN Shaojie;YOU Shaoli(Department of Liver Diseases,The Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第五医学中心肝病医学部肝病科,北京100039

出　　处：《临床肝胆病杂志》2022年第11期2532-2536,共5页Journal of Clinical Hepatology

基　　金：国家“十三五”科技重大专项(2017ZX10203201-004)。

摘　　要：目的探讨慢加急性肝衰竭(ACLF)急性静脉曲张出血(AVB)的危险因素及对预后的影响。方法对解放军总医院第五医学中心2009年—2015年收治ACLF患者1409例随访6个月,根据是否出现AVB分为AVB组(n=167)和非AVB组(n=1242)。计量资料符合正态分布两组间比较使用Student t检验;不符合正态分布资料两组间比较采用Mann-Whitney U检验。Kaplan-Meier法绘制生存曲线,对随访过程中组间病死率及进展进行Log-rank检验。采用二元Logistic回归分析AVB发生的危险因素。结果1409例患者发生AVB 167例,占11.85%。AVB及非AVB患者30 d存活率分别为43.42%、67.79%(χ^(2)=33.558,P<0.001);两组患者180 d存活率分别为18.91%、53.97%(χ2=76.881,P<0.001)。Log-rank检验显示AVB与非AVB患者30 d生存率、180 d生存率差异均有统计学意义(χ^(2)值分别为40.950、89.320,P值均<0.05)。Logistic回归分析AVB发生的危险因素,胸腔积液(OR=1.522,95%CI:1.071~2.162,P=0.019)、急性肾损伤(OR=2.201,95%CI:1.415~3.426,P<0.001)、ACLF分型(OR=2.491,95%CI:1.489~4.168,P=0.001)、ACLF分期(OR=2.403,95%CI:1.687~3.421,P<0.001)及尿素(OR=2.567,95%CI:1.570~4.196,P<0.001)与ACLF患者AVB的发生独立相关。结论AVB是影响ACLF近期生存的重要因素,胸腔积液、急性肾损伤、ACLF分型BC型、ACLF晚期以及尿素是AVB发生的独立危险因素。Objective To investigate the risk factors for acute variceal bleeding(AVB)in acute-on-chronic liver failure(ACLF)and its influence on prognosis.Methods A total of 1409 ACLF patients who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from 2009 to 2015 were followed up for 6 months,and according to the presence or absence of AVB,they were divided into AVB group and non-AVB group.The Student’s t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups.The Kaplan-Meier curves were plotted and the Log-rank test was performed to analyze mortality rate and progression during follow-up,and a binary Logistic regression analysis was used to investigate the risk factors for AVB.Results Among these 1409 patients,167(11.85%)experienced AVB.The 30-day survival rate was 43.42%in the AVB group and 67.79%in the non-AVB group(χ2=33.558,P<0.001),and the 180-day survival rate was 18.91%in the AVB group and 53.97%in the non-AVB group(χ2=76.881,P<0.001).The Log-rank test showed significant differences in 30-and 180-day survival rates between the AVB group and the non-AVB group(χ2=40.950 and 89.320,both P<0.05).The Logistic regression analysis showed that pleural effusion(odds ratio[OR]=1.522,95%confidence interval[CI]:1.071-2.162,P=0.019),acute kidney injury(AKI)(OR=2.201,95%CI:1.415-3.426,P<0.001),ABC subtype of ACLF(OR=2.491,95%CI:1.489-4.168,P=0.001),ACLF stage(OR=2.403,95%CI:1.687-3.421,P<0.001),and urea(OR=2.567,95%CI:1.570-4.196,P<0.001)were independently associated with AVB in ACLF patients.Conclusion AVB is an important influencing factor for the short-term survival of ACLF patients,and pleural effusion,AKI,BC subtype of ACLF,advanced ACLF,and urea are independent risk factors for the onset of AVB.

关 键 词：慢加急性肝功能衰竭 静脉曲张 危险因素 预后 

分 类 号：R575.3[医药卫生—消化系统]