肝硬化食管胃底静脉曲张破裂出血患者预后因素分析

Prognosis of esophageal variceal bleeding risk in patients with liver cirrhosis

[目的]研究讨论肝硬化食管胃底静脉曲张破裂出血(EGVB)患者出现再出血及死亡的预后因素。[方法]以2010年1月~2016年12月我院急诊诊治的131例EGVB患者为研究对象。采用多因素Logistic回归分析以及单因素COX回归分析方法对EGVB患者在院内再出血及院内死亡的预后因素进行分析。[结果]EGVB患者发生院内再次出血的多因素Logistic回归分析显示:年龄、女性、失血量、中性粒细胞百分比、国际标准化比率(INR),淋巴细胞百分比、总胆红素与再出血发生有统计学意义(P<0.05)。单因素cox回归分析显示年龄、女性、Child-Pugh分级、再出血、谷丙转氨酶及、白细胞计数、中性粒细胞百分比是EGVB患者短期预后的危险因素,HR分别为3.558、4.142、2.545、20.560、1.129、1.071和1.009(P<0.05);淋巴细胞是保护因素,HR为0.901(P<0.05)。[结论]年龄、女性、失血量、中性粒细胞百分比、INR为再出血发生的独立危险因素,淋巴细胞百分比增加、总胆红素增加为再出血发生的独立保护因素。年龄、女性、Child-Pugh分级、再出血、谷丙转氨酶和白细胞计数、中性粒细胞百分比是影响EGVB患者住院死亡的预后因素。

[Objective]To evaluate the prognostic factors of rebleeding and death in patients with esoph- ageal and gastric variceal bleeding（EGVB）. [Methods]131 patients with EGVB who were admitted to our hospital from January 2010 to December 2016 were enrolled in this study. Multivariate logistic regression a- nalysis and univariate COX regression analysis were used to analyze the prognostic factors o~ rebleeding and hospital death in patients with EGVB. [Results]Multivariate logistic regression analysis showed that age, female, bleeding volume, neutrophil percentage, international normalized ratio （INR）, lymphocyte per- centage,total bilirubin and rebleeding were statistically significant（P〈0.05）. Univariate cox regression a- nalysis showed that age, female, Child-Pugh classification, rebleeding, alanine aminotransferase, leukocyte count and neutrophil percentage were risk factors for short-term prognosis of patients with EGVB, HR were 3. 558,4. 142,2. 545,20. 560,1. 129,1. 071 and 1. 009（P〈0.05） ;lymphocytes were protective factors, HR was 0. 901（P%0.05）. [Conclusion]The age, female, blood loss, percentage of neutrophils, INR are in- dependent risk factors for rebleeding,while the percentage of lymphocytes increases, and the increase of to- tal bilirubin is an independent protective factor for rebleeding. Age, female, Child-Pugh classification, re- bleeding, alanine aminotransferase and white blood cell count,and percentage of neutrophils were prognos- tic factors for hospitalization in EGVB patients.