肝硬化食管静脉曲张破裂出血相关因素分析

Factors related to esophageal variceal bleeding in patients with liver cirrhosis

目的探讨肝硬化食管静脉曲张破裂出血的相关因素。方法选取2016年1月至2018年1月于西安交通大学第一附属医院就诊的371例肝硬化食管静脉曲张患者为研究对象,分析肝硬化食管静脉曲张破裂出血的影响因素,包括性别、年龄、凝血酶原时间(prothrombin time,PT)、血小板、活化部分凝血酶原时间(activated partial thromboplastin time,APTT)、腹水、脾静脉内径、门静脉内径、肝功能Child-Pugh分级、肝性脑病、肝肾综合征、食管静脉曲张程度和红色征。结果 371例肝硬化食管静脉曲张患者中,发生破裂出血106例,发生率为28.57%。食管静脉曲张破裂出血患者和未破裂出血患者的性别、年龄、PT、APTT、肝功能Child-Pugh分级、肝性脑病和肝肾综合征差异无统计学意义(P> 0.05);食管静脉曲张破裂出血患者血小板水平低于未破裂出血者,脾静脉内径、门静脉内径、腹水发生率、重度食管胃底静脉曲张比例及红色征高于未破裂出血者,差异有统计学意义(P <0.05)。多因素Logistic回归分析表明,血小板、门静脉内径、食管静脉曲张程度和红色征是影响肝硬化食管静脉曲张破裂出血的独立危险因素。结论血小板、门静脉内径、食管静脉曲张程度和红色征是影响肝硬化食管静脉曲张破裂出血的独立危险因素。

Objective To explore the related factors of esophageal variceal bleeding in patients with liver cirrhosis.Methods Total of 371 liver cirrhosis patients with esophageal variceal bleeding in the First Affiliated Hospital of Xi’an Jiao Tong University from January 2016 to January 2018 were selected.The influencing factors of esophageal variceal bleeding in patients with liver cirrhosis,including sex,age,prothrombin time(PT),platelets,activated partial thromboplastin time(APTT),ascites,internal diameter of the splenic vein,portal vein,liver function Child-Pugh classification,hepatic encephalopathy,hepatorenal synthesis,degrees of esophageal varices and red sign were analyzed.Results Among the 371 liver cirrhosis patients with esophageal varices,106 cases occurred rupture and hemorrhage,the incidence rate was 28.57%.There was no significant differences in sex,age,PT,APTT,Child-Pugh grade,hepatic encephalopathy and hepatorenal syndrome between patients with and without esophageal variceal bleeding(P>0.05).The platelet level of patients with esophageal variceal bleeding was lower than that of patients without esophageal variceal bleeding,while splenic vein diameter,portal vein diameter,incidence of ascites,ratio of severe esophageal varices and red sign were higher than those of unruptured bleeding patients,with statistically significant differences(P<0.05).Multivariate Logistic regression analysis showed that platelet,portal vein diameter,esophageal varices degree and red sign were independent risk factors for esophageal variceal bleeding in patients with liver cirrhosis.Conclusions The blood platelet,the internal diameter of the portal vein,the degree of esophageal varicosity and the red sign are the independent risk factors that affect the bleeding of the esophageal varices in patients with liver cirrhosis.