肝硬化食管静脉曲张破裂出血的危险因素分析  

Analysis of risk factors for esophageal varices rupture and bleeding in cirrhosis

作　　者：郑文凤 殷琳琳 李山林[1] 吴玉卓 刘学进[1] ZHENG Wen-feng;YIN Lin-lin;LI Shan-lin;WU Yu-zhuo;LIU Xue-jin(Department of Gastroenterology,Zhoukou Central Hospital,Zhoukou,Henan 466000,China)

机构地区：[1]周口市中心医院消化内科二病区,河南周口466000

出　　处：《医药论坛杂志》2024年第10期1050-1053,共4页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20191457)。

摘　　要：目的研究肝硬化食管静脉曲张破裂出血的危险因素。方法以周口市中心医院消化内科2022年1月—2023年12月293例肝硬化食管静脉曲张患者为研究对象,据患者出血情况将其分为对照组(未破裂出血)和研究组(破裂出血),收集并比较两组患者基本信息、超声检查信息、血液指标及内镜检查信息,行logistic回归分析,分析患者发生破裂出血的危险因素。结果293例患者中出现破裂出血82例,占比27.99%(82/293),未出现破裂出血211例,占比72.01%(211/293);行单因素分析显示,两组患者性别、年龄、饮酒史、肝癌史、肝性脑病、肝硬化类型、PTA、ALT、BUN、脾脏厚度、消化性溃疡、胃底静脉曲张及门脉高压性胃病等方面差异无统计学意义(P>0.05);两组患者食管静脉曲张程度、门静脉内径、脾静脉内径、腹水情况、凝血酶原时间(prothrombin time,PT)、血小板计数(platelet count,PLT)及血清白蛋白(serum albumin,ALB)等方面差异有统计学意义(χ2/t=27.895、13.756、9.336、24.541、11.538、5.464、7.161,P<0.05);logistic分析显示,食管静脉曲张程度、门静脉内径、PT、PLT及ALB为肝硬化食管静脉曲张破裂出血的危险因素(OR=1.578、0.317、0.542、0.002、1.187,P<0.05)。结论食管静脉曲张程度、门静脉内径、PT、PLT及ALB为肝硬化食管静脉曲张破裂出血的危险因素,针对存在危险因素的患者应高度重视,积极干预,从而预防出血,改善预后。Objective To study the risk factors of esophageal varices rupture and bleeding in cirrhosis.Methods A total of 293 patients with esophageal varices with cirrhosis from January 2022 to December 2023 in our hospital were taken as research objects.According to the bleeding conditions of the patients,they were divided into control group(unruptured bleeding)and study group(ruptured bleeding).The basic information,ultrasound information,blood indicators and endoscopic information of the two groups were collected and compared,and logistic regression analysis was performed.The risk factors of rupture bleeding were analyzed.Results Among the 293 patients,82 cases(27.99%)showed rupture hemorrhage,while 211 cases(72.01%)did not.Univariate analysis showed that there were no significant differences between the two groups in gender,age,drinking history,liver cancer history,hepatic encephalopathy,cirrhosis type,PTA,ALT,BUN,spleen thickness,peptic ulcer,gastric varicose vein and portal hypertensive gastropathy(P>0.05).Degree of esophageal varices,portal vein diameter,splenic vein diameter,ascites,prothrombin time(PT),platelet count(PLT)and serum albumin(Serum Albumin)in the two groups ALB)were statistically significant(χ~2/t=27.895,13.756,9.336,24.541,11.538,5.464,7.161,P<0.05).Logistic analysis showed that esophageal variceal degree,portal vein diameter,PT,PLT and ALB were risk factors for esophageal variceal rupture and bleeding in cirrhosis(OR=1.578,0.317,0.542,0.002,1.187,P<0.05).Conclusion Esophageal variceal degree,portal diameter,PT,PLT and ALB are risk factors for esophageal variceal rupture and bleeding in cirrhosis.Patients with risk factors should be highly concerned and actively intervened to prevent bleeding and improve prognosis.

关 键 词：肝硬化 静脉曲张 危险因素 

分 类 号：R657.3[医药卫生—外科学]