乙肝肝硬化并发食管胃底静脉曲张破裂出血的危险因素分析  

Analysis of risk factors for hepatitis B cirrhosis complicated by esophagogastric variceal bleeding

作　　者：陈方璐 雎瑶 王玲玲 杨丽 杨志娟 贾桂 Chen Fanglu;Ju Yao;Wang Lingling;Yang Li;Yang Zhijuan;Jia Gui(Department of Gastroenterology,First Affiliated Hospital of Air Force Medical University(Xijing Hospital),Xi'an 710032,Shaanxi,China;Department of Intervention,First Affiliated Hospital of Air Force Medical University(Xijing Hospital),Xi'an 710032,Shaanxi,China)

机构地区：[1]空军军医大学第一附属医院(西京医院)消化科,陕西西安710032 [2]空军军医大学第一附属医院(西京医院)介入科,陕西西安710032

出　　处：《血管与腔内血管外科杂志》2023年第9期1128-1132,共5页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨乙肝肝硬化并发食管胃底静脉曲张破裂出血(EVB)的危险因素。方法收集2019年10月至2022年8月空军军医大学第一附属医院(西京医院)收治的105例乙肝肝硬化并发食管胃底静脉曲张(GOV)患者的临床资料,采用倾向匹配法根据患者的性别、年龄按1:2的比例及是否发生EVB将患者分为EVB组(n=35)和NEVB组(n=70)。分析乙肝肝硬化患者并发EVB的危险因素以及各个危险因素对乙肝肝硬化并发EVB的预测效能。结果单因素分析结果显示,两组患者有意外创伤史的比例、门静脉内径、红色征阳性的比例、Child-Pugh分级、GOV程度比较,差异均有统计学意义(P﹤0.05)。两组患者的年龄、性别、非甾体药物应用史、血小板计数、凝血酶原时间、血清白蛋白、脾静脉内径比较,差异均无统计学意义(P﹥0.05)。多因素分析结果显示,有意外创伤史、门静脉内径较大、红色征阳性、Child-Pugh分级较高、重度GOV均是乙肝肝硬化患者并发EVB的危险因素(P﹤0.05)。受试者工作特征(ROC)曲线分析结果显示,门静脉内径≥16.71 mm对于乙肝肝硬化患者并发EVB具有中等预测价值,有意外创伤史、红色征阳性、Child-Pugh分级为B级或C级、重度GOV对于乙肝肝硬化患者并发EVB具有较低的预测价值(P﹤0.05)。结论对于乙肝肝硬化患者,应充分评估是否具有并发GOV的危险因素,从而给予针对性的预防和治疗,能够有效降低EVB的发生风险。Objective To investigate the risk factors of hepatitis B cirrhosis complicated with esophagogastric variceal bleeding(EVB).Method The clinical data of 105 patients with hepatitis B cirrhosis and esophago-gastric fundal varices(GOV)admitted to First Affiliated Hospital of Air Force Medical University(Xijing Hospital)from October 2019 to August 2022 were collected.The propensity matching method was used to divide the patients into the EVB group(n=35)and the NEVB group(n=70)in a ratio of 1:2 according to the patient's gender,age,and occurrence of EVB.the risk factors of hepatitis B cirrhosis complicated with EVB and the predictive efficacy of various risk factors for EVB in patients with hepatitis B cirrhosis were analyzed.Result The results of the univariate analysis showed that there were statistically significant differences between the two groups in the proportion of patients with accidental trauma history,portal vein diameter,proportion of positive red sign,Child-Pugh grade,and GOV degree(P<0.05).There were no statistically significant differences in age,gender,history of nonsteroidal drug use,platelet count,prothrombin time,serum albumin,and splenic vein diameter between the two groups of patients(P>0.05).Multifactor analysis results showed that accidental trauma history,larger portal vein diameter,positive red sign,higher Child-Pugh grade,and severe GOV were all risk factors for EVB in patients with hepatitis B cirrhosis(P<0.05).Receiver operator characteristic(ROC)curve analysis results show that portal vein diameter≥16.71 mm has a moderate predictive value for patients with hepatitis B cirrhosis complicated by EVB.Accidental trauma history,positive red sign,Child-Pugh grade B or C,and severe GOV have lower predictive value for EVB in patients with hepatitis B cirrhosis(P<0.05).Conclusion To reduce the risk of EVB in an effective way,it is necessary to fully assess the risk factors for GOV complications in patients with hepatitis B cirrhosis and give targeted prevention and treatment.

关 键 词：乙肝 肝硬化 食管-胃底静脉曲张 破裂出血 危险因素 护理 

分 类 号：R543[医药卫生—心血管疾病]