肝硬化患者胃肠道息肉切除并发出血的危险因素  

Risk factors of gastrointestinal polypectomy concurrent with bleeding in patients with liver cirrhosis

作　　者：崔浩 韩涛[1,2] 徐佰国[1] 王浩宇 赵振刚[1] 李岩[1] Cui Hao;Han Tao;Xu Baiguo;Wang Haoyu;Zhao Zhengang;Li Yan(Department of Hepatology and Gastroenterology,the Third Central Clinical College of Tianjin Medical University,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Artificial Cell Engineering Technology Research Center,Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China;Tianjin Union Medical Center Affiliated to Nankai University,Tianjin 300121,China)

机构地区：[1]天津医科大学三中心临床学院消化肝病科、天津市重症疾病体外生命支持重点实验室、天津市人工细胞工程技术研究中心、天津市肝胆疾病研究所,天津300170 [2]天津市南开大学人民医院,天津300121

出　　处：《中华肝脏病杂志》2023年第2期147-154,共8页Chinese Journal of Hepatology

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-034A)。

摘　　要：目的研究肝硬化患者胃肠道息肉切除伴出血的发生率,并对其相关危险因素进行分析。方法收集天津市第三中心医院内镜中心2017年11月至2020年11月肝硬化胃肠道息肉内镜下治疗者共127例。收集同一时间段内非肝硬化人群胃肠道息肉内镜下治疗共127例进行对照。比较两组患者出血并发症的发生率有无差异,并分析肝硬化组年龄、性别、肝功能情况、外周血白细胞、血红蛋白、血小板、血糖、国际标准化比值(INR)、息肉切除方式、息肉部位及其大小、个数、内镜下形态、病理,及有无合并糖尿病、门静脉血栓、食管胃底静脉曲张情况对息肉切除出血的影响。计量资料组间数据比较采用t检验、秩和检验;计数资料组间数据比较采用χ^(2)检验或Fisher确切概率法;多因素分析采用logistic回归分析。结果肝硬化组息肉切除出血例数为21例,出血率为16.5%;非肝硬化组出血例数为3例,出血率为2.4%,肝硬化组切除息肉时出血率更高(χ^(2)=14.909,P<0.001)。对肝硬化患者胃肠息肉切除伴发出血的危险因素进行单因素分析,显示肝功能分级、血小板、INR、血红蛋白、食管胃底静脉曲张程度及息肉的部位、形态、大小、病理对出血的影响差异有统计学意义(P值均<0.05);多因素logistic回归分析显示肝功能分级、静脉曲张程度及息肉的部位为出血的独立危险因素。肝功能Child-Pugh B级或C级相较于Child-Pugh A级的患者更容易出血(OR=4.102,95%CI:1.133~14.856);胃部息肉比结直肠息肉更容易出血(OR=27.763,95%CI:5.567~138.460);重度食管胃底静脉曲张相较于无静脉曲张或轻中度静脉曲张更容易发生出血(OR=7.183,95%CI:1.384~37.275)。结论肝硬化与非肝硬化人群比较,行内镜下胃肠道息肉切除时发生出血的风险更高。对于肝功能Child-Pugh B级或C级、息肉位于胃部、合并重度食管胃底静脉曲张等高危因素的肝硬化患者Objective To investigate and analyze the occurrence and the related risk factors of gastrointestinal polypectomy accompanied by bleeding in patients with liver cirrhosis.Methods 127 cases of gastrointestinal polyps with cirrhosis who had endoscopy at the Endoscopic Center of Tianjin Third Central Hospital between November 2017 and November 2020 were collected.At the same time,127 cases of gastrointestinal polyps with non-cirrhosis that were treated by endoscopy were collected for comparison.The occurrence of hemorrhagic complications between the two groups was compared.The effects of age,sex,liver function,peripheral blood leukocytes,hemoglobin,platelets,blood glucose,the international normalized ratio(INR),polyp resection method,polyp location,size,number,endoscopic morphology,pathology,the presence or absence of diabetes,portal vein thrombosis,and esophageal varices on polypectomy bleeding in the cirrhosis group were analyzed.The measurement data between groups were compared using the t-test and rank sum test.Theχ^(2) test or Fisher’s exact probability method,and multivariate logistic regression analysis were used for the comparison of categorical data between groups.Results The number of polypectomy bleeding cases in the cirrhotic group was 21,with a bleeding rate of 16.5%.The number of bleeding cases in the non-cirrhotic group was 3,with a bleeding rate of 2.4%.The bleeding rate was higher in the cirrhosis group when polypectomy was performed(χ^(2)=14.909,P<0.001).A univariate analysis of the risk factors for gastrointestinal polypectomy associated with bleeding in patients with liver cirrhosis showed that liver function grading,platelets,INR,hemoglobin,degree of esophageal and gastric varices,and the location,shape,size,and pathology of the polyps had a statistically significant impact on bleeding(P<0.05).Multivariate logistic regression analysis showed that liver function grade,degree of varicose veins,and polyp location were independent risk factors for bleeding.Patients with Child-Pugh B or C grade li

关 键 词：肝硬化 息肉 胃肠道 出血 危险因素 

分 类 号：R575.2[医药卫生—消化系统]