肝硬化并发首次上消化道出血致命的危险因素分析
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摘要
目的:探讨肝硬化并发首次上消化道出血致命的危险因素,为临床防治提供参考。方法:选取在华北理工大学附属医院和唐山市传染病医院收住院的肝硬化患者572例,依据是否并发上消化道出血,分为出血组163例和非出血组409例。再将出血组患者依据是否并发首次上消化道出血死亡,分为病例组(并发首次上消化道出血死亡)65例和对照组(并发非首次上消化道出血死亡)98例。分析患者的一般临床资料及实验室、影像学检查等资料,分析肝硬化并发上消化道出血的危险因素以及肝硬化并发首次上消化道出血致命的独立危险因素。结果:(1)单因素分析显示:出血组和非出血组Hb、PLT、CHE、ALB、TBIL、PT、胃左静脉内径、门静脉内径、肝硬化病程、肝硬化家族史、肝功能Child分级、食管胃底静脉曲张、腹水、肝性脑病、门静脉血栓等方面比较,差异均有统计学意义(P<0.05)。(2)多因素Logistic回归分析显示:胃左静脉内径、食管胃底静脉曲张、腹水、肝功能Child C级、门静脉血栓是肝硬化患者并发上消化道出血的危险因素;胃左静脉内径、食管胃底静脉曲张、门静脉血栓是肝硬化并发首次上消化道出血致命的独立危险因素。结论:更宽的胃左静脉内径、重度食管胃底静脉曲张、门静脉血栓形成是肝硬化并发首次上消化道出血致命的独立危险因素。
Objective: To explore the fatal risk factors of liver cirrhosis complicated with the first upper gastrointestinal bleeding, so as to provide reference for clinical prevention and treatment. Methods:572 patients with cirrhosis admitted to North China University of Science and Technology and Tangshan Infectious Diseases Hospital from January 2014 to January 2018 were selected. According to whether there is concurrent upper gastrointestinal bleeding, it is divided into 163 cases of hemorrhage group and 409 cases of non bleeding group. The patients in the hemorrhagic group were divided into case group(65 cases died of first upper gastrointestinal bleeding) and control group(98 cases died of non-first upper gastrointestinal bleeding). The general clinical data, laboratory and imaging data of the patients were analyzed. The risk factors of upper gastrointestinal bleeding in cirrhosis and the independent risk factors of the first upper gastrointestinal bleeding in cirrhosis were analyzed. Results:(1) Univariate analysis showed that: there were significant differences in Hb, PLT, CHE, ALB, TBIL, PT, left gastric vein diameter, portal vein diameter, course of cirrhosis, family history of cirrhosis, Child classification of liver function, esophagogastric varices, ascites, hepatic encephalopathy and portal vein thrombosis between hemorrhagic and non-hemorrhagic groups(P<0.05). The difference was statistically significant.(2) Multivariate logistic regression analysis showed that the diameter of left gastric vein, esophageal varices, ascites, Child C grade of liver function and portal vein thrombosis were risk factors for upper gastrointestinal bleeding in patients with cirrhosis. Left gastric vein diameter, esophagogastric varices and portal vein thrombosis are independent risk factors for first upper gastrointestinal bleeding in cirrhosis. Conclusion:Wider internal diameter of left gastric vein, severe esophagogastric varices and portal vein thrombosis are independent risk factors for fatal upper gastrointestinal bleeding in cirrhosis.
Objective: To explore the fatal risk factors of liver cirrhosis complicated with the first upper gastrointestinal bleeding, so as to provide reference for clinical prevention and treatment. Methods:572 patients with cirrhosis admitted to North China University of Science and Technology and Tangshan Infectious Diseases Hospital from January 2014 to January 2018 were selected. According to whether there is concurrent upper gastrointestinal bleeding, it is divided into 163 cases of hemorrhage group and 409 cases of non bleeding group. The patients in the hemorrhagic group were divided into case group(65 cases died of first upper gastrointestinal bleeding) and control group(98 cases died of non-first upper gastrointestinal bleeding). The general clinical data, laboratory and imaging data of the patients were analyzed. The risk factors of upper gastrointestinal bleeding in cirrhosis and the independent risk factors of the first upper gastrointestinal bleeding in cirrhosis were analyzed. Results:(1) Univariate analysis showed that: there were significant differences in Hb, PLT, CHE, ALB, TBIL, PT, left gastric vein diameter, portal vein diameter, course of cirrhosis, family history of cirrhosis, Child classification of liver function, esophagogastric varices, ascites, hepatic encephalopathy and portal vein thrombosis between hemorrhagic and non-hemorrhagic groups(P<0.05). The difference was statistically significant.(2) Multivariate logistic regression analysis showed that the diameter of left gastric vein, esophageal varices, ascites, Child C grade of liver function and portal vein thrombosis were risk factors for upper gastrointestinal bleeding in patients with cirrhosis. Left gastric vein diameter, esophagogastric varices and portal vein thrombosis are independent risk factors for first upper gastrointestinal bleeding in cirrhosis. Conclusion:Wider internal diameter of left gastric vein, severe esophagogastric varices and portal vein thrombosis are independent risk factors for fatal upper gastrointestinal bleeding in cirrhosis.
引文
1 韩丹,张韬,张跃新.肝硬化上消化道出血的危险因素分析[J].成都医学院学报, 2016, 11(1):62-64.
2 贺加星, 阴继凯, 刘凡, 等. 肝硬化门静脉高压并发上消化道出血的相关危险因素分析[J]. 中国普通外科杂志, 2015,(1):127-130.
3 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015年更新版)[J]. 临床肝胆病杂志, 2015,31(12):1941-1959.
4 中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南(2015年更新版)[J]. 临床肝胆病杂志, 2015,31(12):1959-1961.
5 中华医学会肝病学分会脂肪肝和酒精性肝病学组. 酒精性肝病诊疗指南(2010年版)[J]. 中华肝脏病杂志, 2010, 18(3): 167-170.
6 中华消化内镜学分会.食管胃底静脉曲张内镜下诊断和治疗规范试行方案[J]. 中华消化内镜学杂志, 2000,17(4):498.
7 于芝瑞, 魏国喜, 刘其昌,等. HBV相关肝硬化合并急性上消化道出血的危险因素分析[J]. 临床肝胆病杂志, 2017, 33(5):860-863.
8 刘佳, 谷建俐. 回顾性分析肝硬化并上消化道出血的临床特征及预后危险因素[J]. 现代消化及介入诊疗, 2018,(1):125-128.
9 童庆华, 彭涛, 丁云. 肝硬化合并上消化道出血的临床特征及预后分析[J]. 检验医学与临床, 2017, 14(17):2627-2629.
10 王亮. 肝硬化门静脉高压症术后门静脉血栓形成危险因素及干预措施分析[J]. 现代中西医结合杂志, 2017, 26(6):626-628.
11 丁惠国, 徐小元, 令狐恩强,等. 《肝硬化门静脉高压食管胃静脉曲张出血的防治指南》解读[J]. 中华内科杂志, 2016, 55(1):57-72.
12 陈志敏, 仇建成, 上官惠敏,等. 肝硬化患者上消化道出血危险因素与预后影响因素分析[J]. 中华医院感染学杂志, 2015(19):4488-4490.
13 刘建军, 牛蓓, 贾海英,等. 重新评价肝硬化腹水发病机制的理论依据与临床研究[J]. 中西医结合肝病杂志, 2015,(2):124-126.
14 肖莉. 乙肝肝硬化并发上消化道出血多因素Logistic回归分析[J]. 热带医学杂志, 2015, 15(11):1520-1523.
15 杨发, 冯燕霞, 马成虎. 肝硬化患者血小板参数、凝血功能及D-二聚体变化与Child-Pugh肝功能分级的关系[J]. 临床消化病杂志, 2016, 28(6):376-378.
16 韩晶, 毛锦娟, 吴时胜,等. 肝硬化上消化道出血患者并发门静脉血栓形成的危险因素[J]. 中华实用诊断与治疗杂志, 2018,32(6):571-574.
17 林国帅, 徐琴, 赵淑一,等. 肝硬化合并门静脉血栓形成的临床特点及其相关危险因素分析[J]. 中华肝脏病杂志, 2016, 24(7):513-517.
18 李玲, 陆申新, 崔春晓,等. 591例肝硬化患者门静脉血栓形成的危险因素分析[J]. 复旦学报(医学版), 2017, 44(3):288-293.
19 刘斌, 张国顺, 杨美荣, 等. 肝硬化并发食管胃底静脉曲张破裂出血与门静脉血栓形成的危险因素[J]. 世界华人消化杂志, 2016, 24(18): 2892-2897.
2 贺加星, 阴继凯, 刘凡, 等. 肝硬化门静脉高压并发上消化道出血的相关危险因素分析[J]. 中国普通外科杂志, 2015,(1):127-130.
3 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015年更新版)[J]. 临床肝胆病杂志, 2015,31(12):1941-1959.
4 中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南(2015年更新版)[J]. 临床肝胆病杂志, 2015,31(12):1959-1961.
5 中华医学会肝病学分会脂肪肝和酒精性肝病学组. 酒精性肝病诊疗指南(2010年版)[J]. 中华肝脏病杂志, 2010, 18(3): 167-170.
6 中华消化内镜学分会.食管胃底静脉曲张内镜下诊断和治疗规范试行方案[J]. 中华消化内镜学杂志, 2000,17(4):498.
7 于芝瑞, 魏国喜, 刘其昌,等. HBV相关肝硬化合并急性上消化道出血的危险因素分析[J]. 临床肝胆病杂志, 2017, 33(5):860-863.
8 刘佳, 谷建俐. 回顾性分析肝硬化并上消化道出血的临床特征及预后危险因素[J]. 现代消化及介入诊疗, 2018,(1):125-128.
9 童庆华, 彭涛, 丁云. 肝硬化合并上消化道出血的临床特征及预后分析[J]. 检验医学与临床, 2017, 14(17):2627-2629.
10 王亮. 肝硬化门静脉高压症术后门静脉血栓形成危险因素及干预措施分析[J]. 现代中西医结合杂志, 2017, 26(6):626-628.
11 丁惠国, 徐小元, 令狐恩强,等. 《肝硬化门静脉高压食管胃静脉曲张出血的防治指南》解读[J]. 中华内科杂志, 2016, 55(1):57-72.
12 陈志敏, 仇建成, 上官惠敏,等. 肝硬化患者上消化道出血危险因素与预后影响因素分析[J]. 中华医院感染学杂志, 2015(19):4488-4490.
13 刘建军, 牛蓓, 贾海英,等. 重新评价肝硬化腹水发病机制的理论依据与临床研究[J]. 中西医结合肝病杂志, 2015,(2):124-126.
14 肖莉. 乙肝肝硬化并发上消化道出血多因素Logistic回归分析[J]. 热带医学杂志, 2015, 15(11):1520-1523.
15 杨发, 冯燕霞, 马成虎. 肝硬化患者血小板参数、凝血功能及D-二聚体变化与Child-Pugh肝功能分级的关系[J]. 临床消化病杂志, 2016, 28(6):376-378.
16 韩晶, 毛锦娟, 吴时胜,等. 肝硬化上消化道出血患者并发门静脉血栓形成的危险因素[J]. 中华实用诊断与治疗杂志, 2018,32(6):571-574.
17 林国帅, 徐琴, 赵淑一,等. 肝硬化合并门静脉血栓形成的临床特点及其相关危险因素分析[J]. 中华肝脏病杂志, 2016, 24(7):513-517.
18 李玲, 陆申新, 崔春晓,等. 591例肝硬化患者门静脉血栓形成的危险因素分析[J]. 复旦学报(医学版), 2017, 44(3):288-293.
19 刘斌, 张国顺, 杨美荣, 等. 肝硬化并发食管胃底静脉曲张破裂出血与门静脉血栓形成的危险因素[J]. 世界华人消化杂志, 2016, 24(18): 2892-2897.
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