乙型肝炎肝硬化患者发生门脉高压性胃病出血相关因素分析

Risk factors for gastric bleeding in patients with hepatitis B-induced liver cirrhosis and portal hypertensive gastropathy

目的分析乙型肝炎肝硬化患者发生门脉高压性胃病出血的相关因素。方法 2014年1月~2015年12月纳入128例乙型肝炎肝硬化患者,对其临床资料进行回顾性分析。根据因素的不同分类,进行单因素分析,对有统计学意义的因素赋值,再行Logistic多因素回归分析,以获得影响乙型肝炎肝硬化患者发生门脉高压性胃病出血的独立危险因素。结果在符合纳入条件的128例乙型肝炎肝硬化患者中,49例(38.3%)发生门脉高压性胃病出血,其中粘膜炎症性糜烂出血41例(32.0%),溃疡性出血8例(6.3%);胃部有基础疾病的患者发生门脉高压性胃病出血的比例为60.0%,显著高于胃部没有基础疾病的患者(30.1%,P<0.05),有幽门螺旋杆菌(HP)感染的患者发生门脉高压性胃病出血的比例为54.8%,显著高于无HP感染的患者(33.0%,P<0.05),存在腹水的患者发生门脉高压性胃病出血的比例为46.3%,显著高于无腹水的患者(23.9%,P<0.05),Child-Pugh C级、B级和A级患者发生门脉高压性胃病出血的比例分别为58.3%、41.5%和15.4%(P<0.05),重度、中度和轻度食管静脉曲张(EV)患者发生门脉高压性胃病出血的比例分别为51.8%、41.9%和6.9%(P<0.05),抗病毒治疗不规律的患者发生门脉高压性胃病出血的比例为55.6%,显著高于抗病毒治疗规律的患者(31.5%,P<0.05),门静脉内径>14 mm的患者发生门脉高压性胃病出血的比例为48.3%,显著高于门静脉内径≤14 mm的患者(30.0%,P<0.05),脾静脉内径>9 mm的患者发生门脉高压性胃病出血的比例为48.4%,显著高于脾静脉内径≤9 mm的(28.8%,P<0.05);多因素分析显示胃部存在基础疾病、Child-Pugh分级差、EV程度高和门静脉内径宽为发生门脉高压性胃病出血的独立危险因素。结论应针对存在出血风险的乙型肝炎肝硬化患者给予风险控制,早期防治。

Objective To analyze the risk factors for gastric bleeding in patients with hepatitis B-induced liver cirrhosis and portal hypertensive gastropathy （PHG）. Methods 128 hepatitis B liver cirrhosis patients with PHG were retrospectively analyzed between January 2014 and December 2015. The incidence of gastric bleeding in each condition was compared. The multivariate Logistic regression analysis was performed to get independent risk factors when any significant statistical results were found. Results In 128 eligible patients with hepatitis B cirrhosis and PHG,49 patients （38.3%） had acute gastric bleeding;the prevalence of acute gastric bleeding in patients with and without underlying gastric diseases were 60.0% vs. 30.1%（P〈0.05）,with and without Helicobacter pylori infection were 54.8% vs. 33.0% （P〈0.05）,with and without ascites were 46.3% vs. 23.9%（P〈0.05）,with Child-Pugh class C,class B and class A were 58.3%,41.5% and 15.4%（P〈0.05）,with severe, moderate and mild esophageal varices （EV） were 51.8%,41.9% and 6.9%（P〈0.05）,with and without regular antiviral therapy were 55.6% vs. 31.5% （P〈0.05）,with portal vein diameter wider than and less than 14 mm were 48.3% vs. 30.0%（P〈0.05）,with splenic vein diameter wider than and less than 9 mm were 48.4% vs. 28.8%（P〈0.05）;Multivariate analysis showed that underlying gastric diseases,poor Child-Pugh classification, severe EV degree and wider portal vein diameter were the independent risk factors for acute gastric bleeding in patients with hepatitis B cirrhosis and PHG. Conclusion The patients with hepatitis B cirrhosis and PHG have a risk of gastrointestinal bleeding,and should be supervised for early prophylaxis and treatment.