肝硬化食管静脉曲张破裂出血风险的分析

Analysis of the risk factors of esophageal variceal bleeding in patients with cirrhosis

目的探讨肝硬化并发食管静脉曲张破裂出血风险的危险因素。方法肝硬化伴有食管静脉曲张患者202例,其中出血组112例,未出血组90例,通过单因素分析和Lo-gistic回归分析,分析临床各项指标与出血的关系,同时评价北意大利内镜协会出血风险指数在出血风险预测中的作用。结果出血组和未出血组在病程、门静脉直径、脾静脉直径、脾脏指数、红色征以及食管静脉曲张Grade分级比较差异具有显著性(P<0·05);Logistic回归模型显示肝硬化并发食管静脉曲张破裂出血的主要预测因素为病程、凝血酶原活动度及红色征。出血组出血风险指数明显高于未出血组(P<0·01),进一步分层分析显示入院期间再出血组凝血酶原活动度明显低于未再出血组(P<0·01),再出血组出血风险指数和未再出血组比较差异无显著性(P>0·05)。结论病程、凝血酶原活动度及红色征是肝硬化并发食管静脉曲张破裂出血的危险因素,出血风险指数在预测出血方面具有重要作用。

Objective To observe the risk factors of esophageal variceal bleeding in patients with cirrhosis. Methods There were 202 cirrhotic patients with esophageal varices, 112 with esophageal variceal bleeding were considered as bleeding group and 90 patients without hemorrhage as non-bleeding group. The relationship between the clinical indexes and esophageal variceal bleeding was investigated by one-way analysis and Logistic regression mode, meanwhile the role of the North Italian Endoscopic Club （NIEC） index was evaluated in prediction of esophageal variceal bleeding. Results Significant differences of course of disease, portal vein diameter, splenic vein diameter, splenic index, red color sign and grade classification of esophageal varice were found between bleeding group and non-bleeding group（P 〈0.05）. Course of disease,prothrombin activity,red color sign are the risk factors of esophageal variceal bleeding in Logistic regression mode. Rev-NIEC index of bleeding group was significantly higher than that of non-bleeding group（P 〈 0. 01 ）, PTA in rebleeding group was significantly lower than that in patients without rebleeding（P 〈 0. 01 ） after stratification, however, no significant difference was observed in Rev-NIEC index between these two groups（P 〉 0. 05）. Conclusion Course of disease, prothrombin activity, red color sign are the risk factors of esophageal variceal bleeding in patients with cirrhosis. Rev-NIEC index may play an important role in prediction of bleeding.