肝硬化患者急性静脉曲张出血的内镜干预时机  

Timing of endoscopic intervention for acute variceal bleeding in patients with liver cirrhosis

作　　者：陈卉卉 张文辉 向慧玲[3] 张丽瑶[4] 原丽莉 王省[6] 吴斌[6] 党彤[7] 张国 呼圣娟[9] 彭利军[10] 高敏[11] 夏冬丽 李嘉[13] 宋瑛 周希乔 齐兴四 曾景 谭小燕[18] 邓明明 方海明[20] 綦盛麟 何松[22] 贺永锋 叶斌[24] 吴伟[25] 邵江波 韦炜 胡建平[28] 雍鑫 何朝晖 暴金伦 张月宁[32] 姬瑞[33] 卜阳 晏维[35] 栗红江 黄义飞 祁小龙 Chen Huihui;Zhang Wenhui;Xiang Huiling;Zhang Liyao;Yuan Lili;Wang Xing;Wu Bin;Dang Tong;Zhang Guo;Hu Shengjuan;Peng Lijun;Gao Min;Xia Dongli;Li Jia;Song Ying;Zhou Xiqiao;Qi Xingsi;Zeng Jing;Tan Xiaoyan;Deng Mingming;Fang Haiming;Qi Shenglin;He Song;He Yongfeng;Ye Bin;Wu Wei;Shao Jiangbo;Wei Wei;Hu Jianping;Yong Xin;He Chaohui;Bao Jinlun;Zhang Yuening;Ji Rui;Bu Yang;Yan Wei;Li Hongjiang;Huang Yifei;Qi Xiaolong(Department of Radiology,Department of Ultrasound,Center of Portal Hypertension,Zhongda Hospital,Southeast University,Nanjing 210009,China;Digestive System Department,Beijing Daxing District People′s Hospital,Beijing 102699,China;Department of Gastroenterology and Hepatology,Tianjin Third Central Hospital,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China;Department of Critical Care Medicine,the Sixth People′s Hospital of Shenyang,Shenyang 110006,China;Department of Gastroenterology,Shanxi Bethune Hospital,Taiyuan 030032,China;Department of Gastroenterology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Gastroenterology,Inner Mongolia Institute of Digestive Disease,the Second Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou 014031,China Zhang Guo;Deparment of Gastroenterology,Guangxi Hospital,the First Affiliated Hospital of Sun Yat-sen University,Nanning 530025,China;Department of Gastroenterology,People′s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750021,China;Department of Gastroenterology,Linyi People′s Hospital,Linyi 276034,China;Department of Gastroenterology,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310009,China;Department of Gastroenterology,Chongqing University Fuling Hospital,Chongqing 408099,China;Department of Gastroenterology and Hepatology,Tianjin Second People′s Hospital,Tianjin 301799,China;Department of Gastroenterology,Xi′an Gaoxin Hospital,Xi′an 7100

机构地区：[1]东南大学附属中大医院放射科、超声科、门静脉高压中心,南京210009 [2]北京市大兴区人民医院消化内科,北京102699 [3]天津市第三中心医院消化(肝病)科、天津市重症疾病体外生命支持重点实验室、天津市肝胆疾病研究所,天津300170 [4]沈阳市第六人民医院重症医学科,沈阳110006 [5]山西白求恩医院消化内科,太原030032 [6]中山大学附属第三医院消化内科,广州510630 [7]内蒙古科技大学包头医学院第二附属医院消化科内蒙古消化病研究所,包头014031 [8]中山大学附属第一医院广西医院消化内科,南宁530025 [9]宁夏回族自治区人民医院消化内科,银川750021 [10]临沂市人民医院消化内科,临沂276034 [11]浙江大学医学院附属邵逸夫医院消化内科,杭州310009 [12]重庆大学附属涪陵医院消化内科,重庆408099 [13]天津市第二人民医院消化内科,天津301799 [14]西安高新医院消化内科,西安710075 [15]南京医科大学第一附属医院消化科,南京210024 [16]青岛大学附属医院消化内科,青岛264299 [17]广州医科大学附属惠州医院急诊科,惠州516002 [18]茂名市人民医院消化内科,茂名525099 [19]西南医科大学附属医院消化内科,泸州646099 [20]安徽医科大学第二附属医院消化内科,合肥230601 [21]大连市第六人民医院肝病科,大连116113 [22]重庆医科大学附属第二医院消化内科,重庆408599 [23]安康市中心医院消化内科内镜中心,安康725099 [24]丽水市中心医院消化内科,丽水323020 [25]温州医科大学附属第一医院消化内科,温州325015 [26]镇江市第三人民医院肝病科,镇江212009 [27]浙江大学医学院附属第二医院消化科,杭州310009 [28]银川市第一人民医院消化内科,银川750003 [29]解放军西部战区总医院消化内科,成都610083 [30]遵义医科大学第五附属(珠海)医院消化内科与内镜科,珠海519180 [31]山南市人民医院消化内科,山南856099 [32]首都医科大

出　　处：《中华消化杂志》2024年第3期156-164,共9页Chinese Journal of Digestion

摘　　要：目的探讨不同时机行内镜干预对肝硬化合并急性静脉曲张出血(AVB)患者预后的影响。方法回顾性分析2013年2月至2020年5月来自以东南大学附属中大医院牵头的中国35所三级医院的2678例肝硬化合并AVB患者的人口统计学和临床数据(包括实验室检查、临床和内镜检查数据)。根据患者接受内镜检查时间分为入院后6 h内行急诊内镜检查(6 h)组(2383例)和入院后6~12 h行急诊内镜检查(6~12 h)组(295例)。为达到基线平衡(即最小混淆),对患者进行1∶1倾向评分匹配后,共纳入588例患者,其中6 h组和6~12 h组各294例。比较倾向评分匹配前后6 h组和6~12 h组患者的5 d内治疗失败发生率和住院病死率,并根据出血史与Child-Pugh分级分析倾向评分匹配后6 h组与6~12 h组各因素亚组患者的5 d内治疗失败发生率。采用Kaplan-Meier法和log-rank检验进行组间比较,采用多因素分析探讨5 d内治疗失败的独立影响因素。结果倾向评分匹配前,6 h组与6~12 h组5 d内治疗失败发生率比较[3.7%(89/2383)比4.7%(14/295)],差异无统计学意义[HR(95%置信区间)1.19(0.67~2.13),P>0.05];6 h组与6~12 h组住院病死率比较[2.8%(67/2383)比2.7%(8/295)],差异无统计学意义(P>0.05)。倾向评分匹配后,6 h组与6~12 h组5 d内治疗失败发生率比较[3.1%(9/294)比4.4%(13/294)],差异无统计学意义[HR(95%置信区间)1.48(0.63~3.45),P>0.05];6 h组与6~12 h组住院病死率比较[2.0%(6/294)比2.7%(8/294)],差异无统计学意义(P>0.05)。倾向评分匹配后亚组分析结果中,仅6 h组与6~12 h组中Child-Pugh分级C级患者5 d内治疗失败发生率比较[1.8%(1/55)比11.8%(6/51)],差异有统计学意义[HR(95%置信区间)6.89(0.83~57.20),P=0.041]。多因素分析结果显示,Child-Pugh分级为C级是肝硬化合并AVB患者5 d内治疗失败的独立影响因素[HR(95%置信区间)2.13(1.12~4.03),P=0.021]。结论肝硬化患者在入院后6 h或6~12 h内进行内镜干预的短期预后相当。Objective To explore the effects of endoscopic intervention at different times on the prognosis of patients with liver cirrhosis complicated with acute variceal bleeding(AVB).Methods From February 2013 to May 2020,the demographic and clinical data(including data from laboratory tests and clinical and endoscopic examinations)of 2678 patients with liver cirrhosis complicated with AVB from 35 tertiary hospitals in China led by Zhongda Hospital Southeast University were retrospectively analyzed.According to the time of endoscopic examination,the patients were divided into emergency endoscopy performed within 6 h after admission group(6 h group)(2383 cases)and emergency endoscopy performed 6 to 12 h after admission group(6 to 12 h group)(295 cases).After 1 to 1 propensity score matching to achieve baseline balance(minimal confounding),a total of 588 patients were enrolled,with 294 patients each in the 6 h group and the 6 to 12 h group.Treatment failure rate and in-hospital mortality within 5 d were compared between the 6 h group and the 6 to 12 h group before and after propensity score matching.According to the history of bleeding and Child-Pugh classification,the treatment failure rate within 5 d was analyzed in the 6 h group and 6 to 12 h group after propensity score matching.The Kaplan-Meier method and log-rank test were performed for comparison between groups.Multivariate analysis was used to identify the independent influencing factors of treatment failure within 5 days.Results Before propensity score matching,there was no statistically significant difference in the treatment failure rate within 5 d between the 6 h group and the 6 to 12 h group(3.7%,89/2383 vs.4.7%,14/295)(HR(95%confidence interval)1.19(0.67 to 2.13),P>0.05).There was no statistically significant difference in in-hospital mortality between the 6 h group and the 6 to 12 h group(2.8%,67/2383 vs.2.7%,8/295,P>0.05).After propensity score matching,there was no statistically significant difference in the treatment failure rate within 5 d between the 6

关 键 词：急性静脉曲张出血 肝硬化 急诊内镜干预时机 5 d内治疗失败率 住院病死率 

分 类 号：R575.2[医药卫生—消化系统]