肝硬化患者食管胃底静脉曲张破裂早期再出血的危险因素分析

Analysis of risk factors for early rebleeding from esophageal and gastric varices in patients with liver cirrhosis

目的探讨影响食管胃底静脉曲张破裂出血(EGVB)患者再出血的危险因素。方法收集宁夏医科大学2006年1月-2009年12月收住入院的432例肝硬化患者,初次治疗后出血停止的325例为对照组(即出血停止组),再出血的107例为研究组(即再出血组)。分析2组患者的临床和相关检查资料。两组间计量资料的比较采用t检验,计数资料的比较采用卡方检验,并进行多个样本率间的多重比较。应用单因素非条件Logistic回归模型分析出血的影响因素。结果性别、吸烟、血红蛋白、白细胞、ALT、AST、脾脏厚度两组患者中差异有统计学意义(P<0.05)。单因素非条件Logistic回归分析中性粒细胞相对值(OR=0.976,P=0.034)、白细胞计数(OR=1.173,P=0.007)、门静脉宽度(OR=7.530,P=0.001)和血红蛋白(OR=1.015,P=0.013)与出血具有相关性。结论白细胞、中性粒细胞、血红蛋白、门静脉为肝硬化食管胃底静脉曲张破裂早期再出血的危险因素。

Objective To investigate the risk factors for early rebleeding from esophageal and gastric varices （EGV）in patients with liver cirrhosis.Methods A total of 432 patients with liver cirrhosis who were admitted to Ningxia Medical University from January 2006 to De-cember 2009 were included in the study.These patients were divided into control group （n=325 ）,who stopped bleeding after initial treat-ment,and study group （n=107）,who had rebleeding after initial treatment.The clinical and test data of the two groups were analyzed. Comparison of measurement data between the two groups was made by t test,while comparison of enumeration data was made by chi-square test;multiple comparison of constituent ratios was made.The univariate unconditional logistic regression model was used for analyzing the risk factors for rebleeding.Results There were significant differences in sex,smoking,hemoglobin （Hb）level,white blood cell （WBC） count,alanine aminotransferase level,aspartate aminotransferase level,and spleen thickness between the two groups （P〈0.05）.The uni-variate unconditional logistic regression analysis showed that percentage of neutrophils （OR=0.976,P=0.034）,WBC count （OR=1.173,P=0.007）,portal vein width （OR=7.530,P=0.001）,and Hb level （OR=1.415,P=0.013）were positively correlated with rebleeding.Conclusion WBC count,percentage of neutrophils,Hb level,and portal vein width are positively correlated with rebleeding from EGV,and they are the risk factors for early rebleeding from EGV in patients with liver cirrhosis if their values are high.