食管静脉曲张内镜治疗术后早期再出血的危险因素分析

Risk factors analysis of early rebleeding after endoscopic treatment of esophageal varices

目的探讨食管静脉曲张内镜治疗术后发生早期再出血的危险因素。方法384例内镜治疗的肝硬化食管静脉曲张病例纳入回顾性分析，先行单因素分析寻找再出血组[n=36（9．4％）]和未出血组（n=348）间的差异性因素，再纳入Logistic回归行多因素分析。结果单因素分析发现肝硬化合并肝癌、肝功能Child—Pugh分级、肝功能Child—Pugh评分、腹水量、门静脉血栓、门静脉宽度、门脉高压性胃病、曲张静脉形态、曲张静脉数量、套扎曲张静脉环数、曲张静脉红色征、白蛋白、总胆红素、凝血酶原时间、凝血酶原活动度、血小板水平在2组间有差异性，进一步多因素分析显示大量腹水（P=0．000，OR=7．614，95％CI：3．590-16．147）、门静脉血栓（P=0．003，OR=2．867，95％CI：1．429-5．750）、门脉高压性胃病（P：0．000，OR=6．212，95％CI：3．036-12．711）、Child—Pugh C级（P=0．008，OR=3．078，95％CI：1．338-7．083）是内镜治疗术后发生早期再出血的独立危险因素。结论肝硬化食管静脉曲张内镜治疗术后早期再出血率较高，对于存在大量腹水、门静脉血栓、门脉高压性胃病以及肝功能Child-PughC级的患者应高度警惕早期再发出血。

Objective To investigate the risk factors of early rebleeding after endoscopic treatment of esophageal varices. Methods A retrospective analysis was performed on the clinical data of 384 cirrhotic patients with esophageal varices. The factors of early rebleeding group [ n = 36 （ 9. 4% ） ] and non-bleeding group （ n = 348 ） were compared by single factor analysis and multivariate analysis of Logistic regression. Results Single factor analysis showed that there were differences between the two groups in cirrhosis with hepatocellular carcinoma, Child-Pugh classification, Child-Pugh score, ascites volume, portal vein thrombosis, portal vein width, portal hypertensive gastropathy, shapes and numbers of varicose veins, numbers of varicose vein ligation, varicose vein red syndrome, albumin, total bilirubin, prothrombin time, prothrombin activity and platelet number. Further multivariate analysis showed that mass ascites （P= 0. 000, OR = 7. 614, 95% CI： 3. 590-16. 147） , portal vein thrombosis （ P = 0. 003, OR = 2. 867, 95% CI： 1. 429- 5. 750） ,portal hypertensive gastropathy （P = 0. 000, OR = 6. 212, 95%CI： 3. 036-12. 711 ） , and Child- Pugh C （P= 0. 008, OR = 3. 078, 95%CI： 1. 338-7. 083） were independent risk factors of early rebleeding after endoscopic treatment. Conclusion The early rebleeding rate was high after endoscopic treatment of esophageal varices. Patients with massive ascites, portal vein thrombosis, portal hypertensive gastropathy and Child-Pugh C should be highly vigilant for early rebleeding.