肝硬化食管静脉曲张破裂出血的危险因素预测

Risk factors of esophageal variceal bleeding in patients with liver cirrhosis

目的探讨肝硬化食管静脉曲张破裂出血(EVB)的危险因素。方法回顾分析2001-02～2011-09该院消化内科住院的肝硬化合并EVB患者42例为出血组,选取同期住院的肝硬化未合并EVB患者38例为对照组,分别统计食管胃底静脉红色征(RC)、食管静脉曲张程度、门静脉内径(PVD)、脾厚度(SPT)、腹水最大液性暗区深度(ASmax)、凝血酶原时间(PT)、血小板(PLT)、血清总胆红素(TB)、血清白蛋白(ALB)、Child-pugh分级等指标进行单因素分析,将差异有统计学意义(P<0.05)的指标进行Logistic回归分析,得出肝硬化患者并发EVB的主要危险因素。结果出血组RC、PT、PVD、SPT、ASmax、食管静脉曲张程度等指标与对照组比较差异均有统计学意义(P<0.01)。但经多元Logistic回归分析发现,RC、PT、PVD、食管静脉曲张程度与食管胃底静脉曲张破裂出血关系密切。结论 RC、PT、PVD、食管静脉曲张程度是影响肝硬化患者EVB的主要因素。

Objective To investigate the risk factors of esophageal variceal bleeding（EVB） in patients with liver cirrhosis.Methods In this retrospective investigation,42 hospitalized patients with liver cirrhosis complicated by EVB in our hospital from February 2001 to September 2011 were selected as EVB group;38 sex-and-age matched hospitalized patients with liver cirrhosis complicated by esophageal varices without bleeding who survived in the corresponding time period were selected as control group.Red-color sign of esophagealgastric fundus varice（RC）,degree of esophageal varices,diameter of portalvein（PV D）,thickness of spleen（SP T）,max depth of ascites（ASmax）,prothrombin time（PT）,platelet count（PLT）,serum total bilirubin（TB）,serum albumin（ALB）,Child-pugh classification,etc,were observed and compared.First all the variables were examined by univariate analysis.Then those with statistical significance in univariate analysis were examined with multivariate analysis using Logistic regression mode,to verify the major risk factors of EVB in patients with liver cirrhosis.Results There were statistically significant differences in RC,PT,PV D,SP T,ASmax and degree of esophageal varices between two groups（P ＆lt;0.01）.But Logistic regession with multivariate analysis revealed that only RC,PT,PV D,degree of esophageal varices were correlated with variceal bleeding significantly.Conclusion RC,PT,PV D,degree of esophageal varices were major factors which may influence variceal bleeding in patients with liver cirrhostis.