肝硬化并发食道胃底静脉曲张破裂出血住院患者预后危险因素分析

The analysis of risk factors associated with prognosis in cirrhotic inpatients complicated with esophageal variceal bleeding

目的:回顾性分析肝硬化并发食道胃底静脉曲张破裂出血住院患者的预后危险因素,为临床工作提供参考依据。方法:收集2006-01-2009-12期间本院连续收治的520例肝硬化并发食道胃底静脉曲张破裂出血患者的临床资料,包括性别、年龄、病因及血压,有无腹水、肝性脑病及是否并发感染,统计血常规、肝肾功能、凝血功能、Child-pugh分级等各项指标,分析治疗方法,包括输血次数和输血量。按预后不同将患者分为死亡组和非死亡组,单因素分析分别采用卡方检验、CMH检验、成组t检验、Wilcoxon秩和检验;多因素分析采用逐步logis-tic回归分析来比较两组患者在各项观察项目方面的差异。结果:经逐步logistic回归分析后表明,与肝硬化并发食道胃底静脉曲张破裂出血住院患者死亡相关的因素有:感染(OR=3.166,95%CI1.214～8.256);年龄(OR=1.052,95%CI1.016～1.090);总胆红素(TBIL)浓度(OR=1.015,95%CI1.011～1.020);血浆白蛋白(ALB)浓度(OR=0.912,95%CI0.849～0.979);输血量(OR=1.513,95%CI1.326～1.726)。结论:本研究表明:感染、高龄、血浆中TBIL升高、低白蛋白血症以及大量输血是肝硬化并发食道胃底静脉曲张破裂出血住院患者死亡的独立危险因素。

Objective：To analysis the risk factors associated with prognosis in cirrhotic inpatients complicated with esophageal variceal （EV） bleeding. Method： Consecutive cirrhotic patients who were admitted to Changhai Hospital from Jan. 2006 to Dec. 2009 because of EV bleeding were retrospectively analyzed. To assess the inde- pendent risk factors for prognosis after EV bleeding, medical assessment was completed at the time of their initial hospital admission, including sex, age, etiology, blood pressure, ascites, hepatic encephalopathy, infection, rou- tine blood test , biochemical, blood coagulation function, Child-pugh grading, and treatment methods. Univariate and multivariate analyses were retrospectively performed. Result：Multivariate stepwise regression analysis showed that four variables were positively correlated with death： the presence of infection （OR= 3. 166, 95 % CI 1. 214- 8. 256） ; age （OR=1. 052, 95% CI 1. 016-1. 090） ; total bilirubin （Tbil） （OR=1. 015, 95% CI 1. 011-1. 020） and the cumulative volume of blood transfusion （OR=1. 513, 95% CI 1. 326-1. 726）. The level of plasma-albu- min （OR=0. 912, 95% CI 0. 849-0. 979） was negatively correlated with death of the cirrhotic inpatients. Conclu- sion：The death risk factors of cirrhotic inpatients complicated with esophageal variceal bleeding were the presence of infection, advanced age, elevated TBIL levels, hypoalbuminemia and massive blood transfusions.