[1]赵迤璇,曹名波.肝硬化并发食管静脉曲张破裂出血的相关危险因素分析[J].新乡医学院学报,2018,35(10):869-873.[doi:10.7683/xxyxyxb.2018.10.006]
　ZHAO Yi-xuan,CAO Ming-bo.Risk factors for esophageal varices bleeding in patients with liver cirrhosis[J].Journal of Xinxiang Medical University,2018,35(10):869-873.[doi:10.7683/xxyxyxb.2018.10.006]
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肝硬化并发食管静脉曲张破裂出血的相关危险因素分析
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
35
期数:
2018年10
页码:
869-873
栏目:
临床研究
出版日期:
2018-10-05

文章信息/Info

Title:
Risk factors for esophageal varices bleeding in patients with liver cirrhosis
作者:
赵迤璇; 曹名波
（河南省人民医院消化内科，河南　郑州　450003）
Author(s):
ZHAO Yi-xuan; CAO Ming-bo
（Department of Digestive System Diseases，Henan Provincial People′s Hospital，Zhengzhou 450003，Henan Province，China）
关键词:
肝硬化; 食管静脉曲张破裂出血; 危险因素
Keywords:
liver cirrhosis; esophageal varices bleeding; risk factor
分类号:
R657.3
DOI:
10.7683/xxyxyxb.2018.10.006
文献标志码:
A
摘要:
目的　探讨影响肝硬化并发食管静脉曲张破裂出血患者的相关危险因素。方法　选择河南省人民医院2015年10月至2017年10月收治的151例肝硬化并发食管静脉曲张破裂出血的患者为出血组，另选择186例肝硬化并发食管静脉曲张未破裂出血的患者为未出血组，对2组患者的一般资料、电子食管胃镜检查情况、血清学检验情况、彩色超声检查情况及肝功能Chid-Pugh分级进行单因素分析，将单因素分析后有差异性的指标再进行非条件logistic 回归分析。结果　2组患者的肝硬化类型及有肝癌、饮酒史、肝性脑病的比例比较差异均无统计学意义（χ2=2.629、0.010、0.094、0.188，P>0.05）；出血组患者有不良饮食习惯、蜘蛛痣的比例显著高于未出血组（χ2=45.444、12.311，P<0.05）。2组患者食管静脉曲张部位距门齿距离及有消化性溃疡的比例比较差异无统计学意义（t=-0.710，χ2=0.092，P>0.05）；2组患者食管静脉曲张程度及有红色征、胃底静脉曲张、门脉高压性胃病的比例比较差异有统计学意义（χ2=-22.312、88.184、90.160、10.610，P<0.05）。2组患者血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、血清尿素氮（BUN）水平比较差异均无统计学意义（P>0.05）；出血组患者血清凝血酶原时间（PT）、总胆红素（TBIL）水平显著高于未出血组（P<0.05），血小板计数（PLT）、凝血酶原活动度（PTA）、血清白蛋白（ALB）水平显著低于未出血组（P<0.05）。2组患者脾脏厚度、腹水分级比较差异无统计学意义（t=0.540，χ2=-1.508；P>0.05）。出血组患者门静脉内径和肝功能Chid-Pugh分级显著高于未出血组（t=12.363，χ2=-5.740；P<0.05）。多因素非条件logistic回归分析结果显示，门静脉内径、PLT、PT、ALB、肝功能Chid-Pugh分级是食管静脉曲张破裂出血的独立危险因素（P<0.05）。出血组患者10~12月发病者所占比例显著高于1~3月、4~6月、7~9月发病者（χ2=12.973、41.994、22.754，P<0.05）；1~3月发病者所占比例显著高于4~6月、7~9月发病者（χ2=9.537、3.886，P<0.05）；4~6月发病者所占比例与7~9月发病者比较差异无统计学意义（χ2=1.329，P>0.05）。结论　门静脉内径、PLT、PT、ALB、肝功能Chid-Pugh分级为肝硬化并发食管静脉曲张破裂出血的独立危险因素。
Abstract:
Objective　To investigate the risk factors of esophageal varices bleeding in patients with liver cirrhosis.Methods　A total of 151 patients with liver cirrhosis complicated with esophageal variceal bleeding in Henan Provincial People′s Hospital from October 2015 to October 2017 were selected as bleeding group，and a total of 186 patients with liver cirrhosis complicated with unruptured esophageal varices were selected as non-bleeding group.The general data，the results of electronic esophagogastroscopy，serological examination，color Doppler ultrasound and Chid-Pugh classification of liver function were analyzed by univariate analysis.The indexes with statistical difference after univariate analysis were analyzed by non-conditional logistic regression analysis.Results　There was no significant difference in the type of cirrhosis and the proportion of liver cancer，drinking history and hepatic encephalopathy between the two groups（χ2=2.629，0.010，0.094，0.188；P>0.05）.The proportion of bad eating habits and spider nevus in bleeding group was significantly higher than that in non-bleeding group（χ2=45.444，12.311；P<0.05）.There was no significant difference in the distance between esophageal varices site and incisors and the proportion of peptic ulcer between the two groups（t=0.710，χ2=0.092；P>0.05）.There were significant differences in the degree of esophageal varices and the proportions of red-color sign，gastric varices and portal hypertensive gastropathy between the two groups（χ2=-22.312，88.184，90.160，10.610；P<0.05）.There was no significant difference in serum alanine transaminase（ALT），aspartic transaminase（AST） and blood urea nitrogen（BUN） levels between the two groups（P>0.05）.The serum prothrombin time（PT） and total bilirubin（TBIL） levels in the bleeding group were significantly higher than those in the non-bleeding group（P<0.05）；and the platelet（PLT），prothrombin activity（PTA） and serum albumin（ALB） levels in the bleeding group were significantly lower than those in the non-bleeding group（P<0.05）.There was no significant difference in the thickness of spleen and ascites classification between the two groups（t=0.540，χ2=-1.508；P>0.05）.The internal diameter of portal vein and the Chid-Pugh classification of liver function in the bleeding group were significantly higher than those in the non-bleeding group（t=12.363，χ2=-5.740；P<0.05）.Multivariate unconditional logistic regression analysis showed that portal vein diameter，PLT，PT，ALB and Chid-Pugh classification of liver function were the independent risk factors for esophageal variceal bleeding（P<0.05）.In the bleeding group，the incidence from October to December was significantly higher than that from January to March，April to June，July to September（χ2=12.973，41.994，22.754；P<0.05）；and the incidence from January to March was significantly higher than that from April to June，July to September（χ2=9.537，3.886；P<0.05）.There was no significant difference in the incidence between April to June and July to September（χ2=1.329，P>0.05）.Conclusion　The portal vein diameter，PLT，PT，ALB and Chid-Pugh classification of liver function are the independent risk factors for esophageal varices bleeding in liver cirrhosis patients.

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更新日期/Last Update: 2018-10-05