肝硬化上消化道出血与季节变化的时间序列分析

Analysis of relationship between upper gastrointestinal bleeding caused by cirrhosis and seasonal variation of time series

目的运用时间序列分析法探讨肝硬化上消化道出血发病的季节规律。方法以＂肝硬化＂和＂上消化道出血＂为关键词,检索中山大学附属第一医院病案室1999-01-01—2006-12-31住院病例共469例。按照中国阴阳历的季节划分标准划分季节,统计各季节发病构成比;运用χ2分析Child-Pugh分级分布与四季的关系;运用时间序列分析法分析肝硬化上消化道出血的时间规律;运用相关分析法分析肝硬化上消化道出血的时间规律与气温的关系。结果 1999—2006年,肝硬化上消化道出血冬、春季发病构成比明显高于夏、秋季,并且各年变化趋势相似;Child-Pugh分级B、C级冬、春季发病率明显高于夏季（P〈0.05）,B＋C级冬、春季发病率高于夏、秋季（P〈0.05）;肝硬化上消化道出血发病1~4月、12月及冬、春季的季节指数均〉100,且再出血冬、春季的季节指数〉100;肝硬化上消化道出血各月患者人数构成比与该月平均气温呈明显负相关（r=-0.886,P〈0.01）。结论肝硬化上消化道出血事件的发生与季节变化有一定关系,主要发生在冬、春季,冬、春季节人体内热外寒的体质可能是肝硬化患者发生上消化道出血的内在机制。

Objective To research the relationship between upper gastrointestinal bleeding caused by cirrhosis and seasonal variation of time series.Methods The cases with of ＂hepatic cirrhosis＂ and ＂upper gastrointestinal bleeding＂ were retrieved from 1999-01-01 to 2006-12-31 in the record room of the first affiliated hospital of Sun Yat-sen University.Totally 469 cases of upper gastrointestinal bleeding are retrieved.Seasons was divided by Chinese lunisolar calendar.And incidence of upper gastrointestinal bleeding was recorded in different seasons.The relationship between distribution of four seasons and Child-Pugh classification were analyzed byχ2 analysis.The time pattern of upper gastrointestinal bleeding in patients with cirrhosis was analyzed using time series analysis method.The relationship of temporal patterns of upper gastrointestinal bleeding in cirrhosis and temperature was evaluated by correlation analysis method.Results The constituent ratio of upper gastrointestinal bleeding in cirrhosis in winter and spring was significantly higher than the incidence in summer and autumn and similar trends each year Incidence of B C-class of Child-Pugh classification in winter and spring was significantly higher than that in summer（P〈0.05）.Incidence of B＋ C-class in winter and spring was significantly higher than that in summer and autumn（P〈0.05）.The seasons index of upper gastrointestinal bleeding in cirrhosis from January to April December and winter and spring 〉100 and seasons index of bleeding in winter and spring 〉100 Incidence of upper gastrointestinal bleeding in different months was negative correlation with average temperature of the month（r=-0.886 P〈0.01）.Conclusion The events of upper gastrointestinal bleeding in patients with cirrhosis have a certain relationship with the seasonal variation and occur mainly in winter and spring.The body with endogenous heat and exogenous cold in winter and spring may be the internal mechanism of upper gastrointestinal bleeding in patients with cirrhosis.