HBV相关肝硬化合并急性上消化道出血的危险因素分析

Risk factors for HBV-related liver cirrhosis complicated by acute upper gastrointestinal bleeding

目的分析HBV相关肝硬化合并急性上消化道出血(AUGIB)的危险因素。方法以2011年1月-2011年12月于巩义市人民医院住院的58例HBV相关肝硬化合并AUGIB患者为研究组,另外随机抽取同期未发生上消化道出血的100例HBV相关肝硬化患者为对照组。收集其入院时的一般临床资料。计量资料组间比较采用t检验;计数资料组间比较采用χ~2检验。采用多因素Cox回归模型分析其影响AUGIB的危险因素;采用life tables法统计患者1、2、3年累积生存率并绘制生存曲线。结果 HBV相关肝硬化并发AUGIB患者的1、2、3年的累积生存率分别为72.2%、51.9%、35.2%,中位生存时间是24.7个月。单因素分析结果显示:出血史(χ~2=7.128,P=0.008)、病程(t=8.283,P<0.001)、不良饮食习惯(χ~2=7.612,P=0.006)、Child-Pugh分级(χ~2=6.045,P=0.049)、食管静脉曲张程度(χ~2=46.241,P<0.001)、胃底静脉曲张(χ~2=14.211,P<0.001)及门静脉高压(χ~2=6.846,P=0.009)在2组间比较,差异均有统计学意义。多因素Cox回归分析显示,病程[(风险比)RR=0.745,95%CI(95%可信区间):0.824~0.967,P=0.026]、不良饮食习惯(RR=1.426,95%CI:1.033~2.582,P=0.032)、Child-Pugh分级(RR=2.032,95%CI:1.05~2.34,P=0.036)、食管静脉曲张程度(RR=0.796,95%CI:1.23~3.37,P=0.015)、胃底静脉曲张(RR=0.825,95%CI:2.46~3.92,P=0.043)、门静脉高压(RR=0.983,95%CI:1.26~3.75,P=0.007)为AUGIB发生的独立危险因素。结论病程、不良饮食习惯、Child-Pugh分级、食管静脉曲张程度、胃底静脉曲张以及门静脉高压是影响HBV相关肝硬化并发AUGIB的独立危险因素,临床医生应加以重视,以期改善患者的预后。

Objective To investigate the risk factors for HBV - related liver cirrhosis complicated by acute upper gastrointestinal bleeding （AUGIB）. Methods A total of 58 patients with HBV - related liver cirrhosis complicated by AUGIB who were hospitalized in our hospital from January to December, 2011 were enrolled as study group, and 100 patients with HBV -related liver cirrhosis who did not experience upper gastrointestinal bleeding during the same period of time were enrolled as control group. Their general clinical data were collected. The t - test was used for comparison of continuous data between groups, the chi - square test was used for comparison of categorical data between groups, the nmhivariate Cox regression model was used to analyze the risk factors, and the life table method was used to analyze l - , 2 - , and 3 - year cumulative survival rates and plot survival curves. Results The 1 -, 2 - , and 3 - year cumulative survival rates in the pa- tients with HBV -related liver cirrhosis complicated by AUGIB were 72.2% , 51.9%, and 35.2% , respectively, with a median survival time of 24.7 months. The univariate analysis showed that AUGIB was associated with bleeding history （x^2 =7. 128, P =0. 008）, course of disease （ t = 8.283, P 〈 0. 001 ） , bad eating habits （x^2 = 7. 612, P = 0. 006） , Child - Pugh class （x^2 = 6.045, P = 0.049 ） , degree of esophageal varices （x^2 = 46. 241, P 〈 0. 001 ）, gastric varices （x^2 = 14. 211, P 〈 0. 001 ）, and portal hypertension （x^2 =6. 846, P = 0. 009 ）. The multivariate Cox regression analysis revealed that course of disease （ RR = 0. 745, 95% CI ： 0. 824 - 0. 967, P = 0. 026） , bad eating habits （RR = 1.426, 95%CI： 1.033-2.582, P=0.032）, Child-Pugh class （RR =2.032, 95%CI： 1.05-2.34, P =0.036）, degree of esophageal varices （ RR = 0. 796, 95% CI ： 1.23 - 3.37, P = 0. 015 ） , degree of gastric varices （ RR = 0. 825, 95% Cl ： 2.46 - 3.92, P = 0. 043 ） , and portal hypertension （ RR = 0.983, 95 % CI ： 1.26 - 3.75, P = 0.007 ） were independent risk factors for the progno- sis of patients with HBV - related liver cirrhosis complicated by AUGIB. Conclusion Course of disease, bad eating habits, Child - Pugh class, degree of esophageal varices, degree of gastric varlces, and portal hypertension are independent risk factors for the prognosis of pa- tients with HBV - related liver cirrhosis complicated by AUGIB. These factors should be taken seriously by clinical physicians to improve pa- tients＇ prognosis.