组织黏合剂治疗胃底静脉曲张术后再出血的相关因素

Factors affecting re-bleeding after injection of cyanoacrylate for gastric varices

目的:分析内镜下胃底组织黏合剂注射治疗(gastric varices injection,GVI)术后胃底静脉曲张再出血的发生率及与肝硬化疾病相关的影响其再出血的危险因素.方法:回顾性分析我院2010-06/2012-04因肝硬化伴重度胃底静脉曲张住院并行首次胃底组织黏合剂治疗的患者52例.记录其性别、年龄、肝硬化原因、是否合并肝癌、Child分级、腹水、门静脉栓塞、门静脉直径、脾静脉直径、脾脏厚度、脾脏长径、血常规、肝肾功能、凝血功能、空腹血糖(fasting blood sugar,FBs)、甲胎蛋白(alpha-fetal Protein,AFP)、Child评分、MELD评分以及内镜下静脉曲张情况等指标.寻找其与肝硬化疾病相关的影响首次GVI术后胃底静脉曲张破裂出血(gastric variceal bleeding,GVB)可能的危险因素.结果:首次GVI术后胃底静脉曲张破裂再出血率34.6%,平均再出血时间为5.5mo±4.9mo.Logistic回归分析表明,Child-PughB/C级、-谷氨酰转肽酶(gamma-glutamyl transpeptidase,GGT)、脾脏长径是与肝硬化疾病相关的影响GVI术后GVB的危险因素,P值分别为0.036、0.009、0.033,OR值分别为15.262、47.684、38.249,95%CI分别为1.197-194.573、2.604-873.328、1.339-1092.543.GGT、脾脏长径的ROC曲线下面积分别为0.773、0.704,敏感度分别为66.7%、93.8%,特异度分别为85.7%和52.6%.结论:Child-PughB/C、GGT及脾脏长径是与肝硬化相关的影响GVI术后胃底静脉曲张再出血的危险因素.

AIM： To investigate the rate of re-bleeding after injection of cyanoacrylate for gastric varices in patients with large gastric varices and to identify probable risk factors for re-bleeding. METHODS： A retrospective analysis was carried out in 52 cirrhotic patients who had large gastric varices and underwent endoscopic cyanoacrylate injection at our hospital from June 2010 to April 2012. To identify probable risk factors for re-bleeding after injection of cyanoacrylate for gastric varices, various factors were collected and analyzed, including gender, age, types of cirrhosis, coexistent hepatocellular carcinoma, Child-Pugh classification, presence of ascites, portal vein thrombosis, diameter of por-tal vein and spleen vein, spleen length, spleen thickness, routine blood tests, liver function tests, renal function tests, coagulation function tests, fasting blood sugar,α fetal protein, Child score, MELD score, and endoscopic variceal characteristics. RESULTS： Recurrent bleeding occurred in 18 patients （34.62%） after initial cyanoacrylate injection, and the mean re-bleeding time was 5.5 mo ± 4.9 mo. Logistic regression analysis revealed that Child-Pugh classification, gamma-glutamyl transpeptidase （GGT） and spleen length were probable risk factors for recurrent bleeding after cyanoacrylate injection （P = 0.036, 0.009, 0.033; OR = 15.262, 47.684, 38.249; 95%CI： 1.197-194.573, 2.604-873.328, 1.339-1 092.543）. The areas under ROC curve of GGT and spleen length in the diagnosis of re-bleeding were 0.773 and 0.704, with sensitivities of 66.7% and 93.8% and specificities of 85.7% and 52.6%. CONCLUSION： Recurrent bleeding after injection of cyanoacrylate for gastric varices is affected by Child-Pugh B or C, GGT and spleen length.