食管胃底静脉曲张出血内镜治疗后排胶出血的危险因素分析

Risk factors for glue extrusion bleeding after endoscopic therapy for esophagogastric variceal bleeding

目的分析组织黏合剂注射治疗食管胃底静脉曲张后排胶出血的危险因素。方法收集2008年10月-2016年1月于首都医科大学附属北京地坛医院住院治疗的肝硬化食管胃底静脉曲张出血或曾经出血的416例患者的临床资料,包括性别、年龄、病因、血常规、肝肾功能、电解质、血脂、凝血、门静脉内径、脾前后径、Child-Pugh评分及组织黏合剂注射剂量等指标。计量资料组间比较采用t检验;多因素分析采用logistic回归分析。结果共59例患者出现排胶出血,发生率为14.18%。单因素分析显示,排胶出血患者和无排胶出血患者的TBil、DBil、总胆汁酸、Child-Pugh评分和组织黏合剂注射量比较差异均有统计学意义(t值分别为2.54、2.85、2.35、1.03、4.38,P值均<0.05)。多因素logistic回归分析显示,Child-Pugh评分(比值比=2.714,95%可信区间:1.600~4.850,P=0.009)和组织黏合剂注射量(比值比=2.925,95%可信区间:1.762~5.124,P=0.008)为排胶出血的独立危险因素。结论 Child-Pugh评分越高,组织黏合剂注射量越大,患者发生排胶出血的风险越高。

Objective To investigate the risk factors for glue extrusion bleeding after endoscopic tissue adhesive injection for the treatment of esophagogastric variceal bleeding.Methods A total of 416 patients with liver cirrhosis complicated by esophagogastric variceal bleeding or a past history of bleeding who were admitted to Beijing Ditan Hospital,Capital Medical University,from October 2008 to January 2016 were enrolled.A retrospective analysis was performed for their clinical data,including sex,age,etiology,routine blood test results,hepatic and renal function,electrolytes,blood lipids,coagulation,diameter of the portal vein,anteroposterior diameter of the spleen,Child-Pugh score,and volume of tissue adhesive injection.The t-test was used for comparison of continuous data between groups,and a multivariate logistic regression analysis was also performed.Results Of all patients,59 experienced glue extrusion bleeding,resulting in an incidence rate of 14.18%.The univariate analysis showed that there were significant differences in total bilirubin,direct bilirubin,total bile acid,Child-Pugh score,and volume of tissue adhesive injection between the patients with glue extrusion bleeding and those without(t=2.54,2.85,2.35,1.03,and 4.38,all P<0.05).The multivariate logistic regression analysis showed that Child-Pugh score(odds ratio[OR]=2.714,95%confidence interval[CI]1.600-4.850,P=0.009)and volume of tissue adhesive injection(OR=2.925,95%CI 1.762-5.124,P=0.008)were independent risk factors for glue extrusion bleeding.Conclusion Patients with higher Child-Pugh score and volume of tissue adhesive injection tend to have a higher risk of glue extrusion bleeding.