肝硬化食管静脉曲张出血患者硬化治疗的生存分析

The effect of sclerotherapy of bleeding esophageal variceal on survival of cirrhotic patients

目的 研究肝硬化食管静脉曲张出血 (CEVB)硬化治疗的各种因素对预后生存的影响 ,并进行定量分析 ,建立生存模型 ,估计生存率。方法 对我院 1 987年 4月至 2 0 0 0年 6月间 670例CEVB硬化治疗患者的 2 9项预后因子及生存期的随访资料采用Kaplan Meier法进行生存率的估计 ,以Cox比例风险模型进行危险因素分析。结果 Cox模型分析结果为肝功能Child分级与曲张静脉转归是 2个显著影响预后生存的因素。 1、3、5年生存率分别是 93 2 9%、85 2 4 %、74 2 7%。肝功能Child分级为A、B、C级者 ,1年生存率分别是 98 88%、95 97%、82 32 % ,5年生存率分别是 91 42 %、78 35 %、49 48% ,其生存曲线有明显差异。食管曲张静脉转归分为消失、基本消失、Ⅰ度、Ⅱ度、Ⅲ度 ,其 1年生存率分别是 96 0 8%、93 94%、85 84%、85 0 0 %、53 85 % ,5年生存率分别是 81 45 %、67 76 %、72 89%、61 59%、35 90 % ,生存曲线有明显差异 ,其Cox模型单因素和多因素分析P值分别为 0 0 0 0和 0 0 2 0。但 5条曲线在 50个月时有聚合趋势 ,可能说明硬化治疗静脉曲张改善保持时间约为 4年。肝功能ChildC级时静脉曲张转归为消失和基本消失者 ,其 1年生存率均为 88 2 4 % ,2年生存率为77 98%～ 83 63 % ,仍高于总体肝功能ChildC级时?

Objective To investigate the effect of various factors in sclerotherapy of cirrhotic esophageal variceal bleeding (CEVB) on the prognosis, model of survival was established Methods Kaplan Meier analysis was applied in patients with CEVB treated by sclerotherapy from April 1987 to June 2000 to evaluate the survival, with follow up data of survival and 29 selected factors of prognosis Risk factors were identified with Cox′s Proportional Hazard Model Results Cox′s model shows that Child grading and outcome of varices are two factors that significantly influence the prognosis and survival Survival of 1, 3 and 5 year for the entire group is 93 29%, 85 24% and 74 27%, respectively Survival of 1 year for patients of Child grade A, B and C is 98 88%, 95 97% and 82 32%, respectively, and survival of 5 year is 91 42%, 78 35% and 49 48%, respectively, with significant difference in survival curves Outcome of esophageal varices is labeled with elimination, basically elimination, degree Ⅰ, degree Ⅱ and degree Ⅲ, and survival of 1 year is 96 08%, 93 94%, 85 84%, 85 00% and 53 85%, respectively, survival of 5 year is 81 45%, 67 76%, 72 89%, 61 59% and 35 90%, respectively, with significant difference in survival curves In patients of Child grade C with outcome of elimination or basically elimination, 1 year survival is 88 24%, and 2 year survival is 77 98%～83 63% Survival curves of stratified groups are tended to converge after 50 months Conclusions Sclerotherapy for CEVB is an effective therapy to arrest emergent bleeding and prevent rebleeding For patients of Child grade C, survival can also be prolonged, so it is advisable to take active measures Repeat of sclerotherapy after about 4 years may be necessary Sclerotherapy can significantly prolong the survival