合并肝细胞癌对肝硬化食管胃静脉曲张出血患者急诊内镜治疗预后的影响  

Impact of hepatocellular carcinoma on the prognosis of patients with liver cirrhosis undergoing emergency endoscopic therapy due to esophagogastric variceal bleeding

作　　者：朱小琴 韦娜 肖勇[1] 余保平[1] ZHU Xiaoqin;WEI Na;XIAO Yong;YU Baoping(Department of Gastroenterology,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院消化内科,武汉430060

出　　处：《临床肝胆病杂志》2025年第2期277-283,共7页Journal of Clinical Hepatology

基　　金：湖北省卫生计生面上项目(WJ2023M078)。

摘　　要：目的探究合并肝细胞癌(HCC)对肝硬化食管胃静脉曲张出血患者急诊内镜治疗预后的影响,并分析肝硬化食管胃静脉曲张出血未合并HCC患者急诊内镜治疗预后的独立影响因素。方法选取武汉大学人民医院2017年1月—2023年7月肝硬化食管胃静脉曲张出血经急诊内镜治疗且未合并HCC患者117例,合并HCC患者119例。收集患者年龄、性别等基本信息;是否合并高血压、糖尿病、冠心病等慢性疾病情况;入院后行急诊内镜时间,INR、Alb、肌酐、钠、TBil、ALT、AST等肝功能相关指标。正态分布的连续型变量两组间比较采用成组t检验;非正态分布连续型变量两组间比较采用Wilcoxon秩和检验。分类变量组间比较采用χ^(2)检验。用协方差分析及多因素Logistic回归分析控制基线变量再对结局变量进行比较,并绘制两组生存时间的Kaplan-Meier曲线;对未合并HCC组生存时间进行单因素及Cox多因素回归分析,分析生存时间的独立影响因素,并进一步分组进行Kaplan-Meier曲线绘制及Log-rank检验,验证独立影响因素,并分析次要结局的独立影响因素。结果合并HCC组红细胞输注单位明显高于未合并HCC组[6.00(2.00~9.00)vs 4.00(1.75~7.00),Z=−2.050,P=0.040,F=4.869,调整P=0.028],生存时间明显低于未合并HCC组[(29.77±16.01)d vs(38.07±11.43)d,t=4.574,P<0.001,F=17.294,调整P<0.001],5 d再出血情况明显高于未合并HCC组(22.69%vs 6.84%,χ^(2)=11.736,P<0.001,调整P=0.021);Kaplan-Meier曲线显示合并HCC组42 d死亡风险是未合并HCC组的3.897倍(95%CI:2.338~6.495,P<0.001);对未合并HCC组进行Cox多因素回归分析显示,住院总时长(HR=0.793,95%CI:0.644~0.976,P=0.029)是此类患者42 d生存情况的独立保护因素;Kaplan-Meier曲线显示住院时长>9 d,有利于患者预后(HR=4.302,95%CI:1.439~12.870,P=0.037);血Na水平(OR=0.523,95%CI:0.289~0.945,P=0.032)及MELD-Na评分(OR=0.495,95%CI:0.257~0.954,P=0.036)是5 d再出血情况的独立保护因Objective To investigate the impact of hepatocellular carcinoma(HCC)on the prognosis of patients with liver cirrhosis undergoing emergency endoscopic therapy for esophagogastric variceal bleeding,as well as independent influencing factors for the prognosis of liver cirrhosis patients without HCC after emergency endoscopic therapy for esophagogastric variceal bleeding.Methods A total of 117 liver cirrhosis patients without HCC and 119 liver cirrhosis patients with HCC who underwent emergency endoscopic therapy for esophagogastric variceal bleeding in Renmin Hospital of Wuhan University from January 2017 to July 2023 were enrolled.Basic information including age and sex was collected from all patients,as well as the presence or absence of chronic diseases such as hypertension,diabetes,and coronary heart disease,the time of emergency endoscopy after admission,and liver function parameters including international normalized ratio,albumin,creatinine,sodium,total bilirubin,alanine aminotransferase,and aspartate aminotransferase(AST).The independent-samples t test was used for comparison of normally distributed continuous variables between two groups,and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous variables between two groups;the chi-square test was used for comparison of categorical variables between groups.The covariance analysis and the multivariate logistic regression analysis were used for comparison of outcome variables after control of baseline variables,and the Kaplan-Meier survival curve was plotted for each group.The univariate and multivariate Cox regression analyses were performed for survival time in the non-HCC group to investigate the independent influencing factors for survival time,and then the Kaplan-Meier curve analysis and the log-rank test were performed to validate such independent influencing factors and analyze the independent influencing factors for secondary outcomes.Results Compared with the non-HCC group,the HCC group had significantly higher red

关 键 词：肝硬化 食管和胃静脉曲张 癌 肝细胞 预后 

分 类 号：R73[医药卫生—肿瘤]