影响肝硬化食管胃底静脉曲张破裂出血住院患者预后的有关因素分析

Prognostic Factors of Patients with Acute Gastroesophageal Variceal Bleeding Caused by Liver Cirrhosis

目的分析肝硬化食管胃底静脉曲张破裂出血住院患者短期预后因素。方法总结2000年1月~2006年12月因肝硬化食管胃底静脉曲张破裂出血首次住院的肝硬化患者175例资料,记录患者入院时生命体征、化验结果、治疗方案、出院情况,按公式计算Child-Pugh分级、MELD评分。男121例,女54例。住院死亡11例。结果单因素Cox回归分析显示Child-Pugh分级、MELD评分、出血次数、血白细胞计数、凝血酶原时间、国际标准化比率（INR）是肝硬化食管胃底静脉曲张破裂出血短期预后的危险因素,HR分别为8.956、1.020、3.449、1.112、1.134和2.359（P〈0.05）;血钠、血白蛋白和凝血酶原活动度是保护因素,HR分别为0.856、0.857和0.919（P〈0.05）。结论 Child-Pugh分级、MELD评分、血白细胞计数以及血钠是影响肝硬化食管胃底静脉曲张破裂出血患者住院死亡的预后因素。

Objective To evaluate the prognostic factors of patients with liver cirrhosis,who were hospitalized for acute esophageal variceal bleeding（GEVB）. Methods Retrospectively analyzed 175 patients（121 male and 54 female） with liver cirrhosis who were admitted to our hospital for acute GEVB from January 2000 to December 2006.The vital signs,laboratory results,regimen,Child-Pugh grade and MELD（model for end stage liver disease） score were recorded.In the patients,11 died at the hospital.Results Single factor Cox regression analysis showed that Child-Pugh grade,MELD score,bleeding frequency,WBC count,prothrombin time and international normalized ratio（INR） were risk factors for short-term prognosis（HR=8.956,1.020,3.449,1.112,1.134 and 2.359,respectively,P0.05）.Whereas,serum concentration of Na＋ and albumin,and prothrombin time activity percentage were protective factors（HR=0.856,0.857 and 0.919,respectively,P0.05）.Conclusion Child-Pugh grade,MELD score,WBC count and serum concentration of Na＋ are prognostic factors for hospital mortality of patients with liver cirrhosis-induced acute GEVB.