慢加急性肝衰竭患者并发上消化道出血的危险因素分析

Risk factors of acute-on-chronic liver failure complicated with upper gastrointestinal bleeding

目的探讨慢加急性肝衰竭(ACLF)患者并发上消化道出血的危险因素。方法选择2010—2018年新疆医科大学第一附属医院住院诊断为ACLF患者154例;根据上消化道出血与否分为出血组54例和未血组100例。收集患者的一般临床资料、实验室及影像学检查等资料,多因素Logistic回归分析方法分析ACLF并发上消化道出血的危险因素。结果单因素分析显示:并发症(肝性脑病、肝肾综合征),胃底静脉曲张(重度)、中性粒细胞百分比、D-二聚体、纤维蛋白(原)降解产物、总蛋白、降钙素原、门静脉宽度、IL-6等指标差异均有统计学意义(χ^2=8.035、6.404、48.06,Z=-3.391、-5.017、-5.118、-3.698、-2.367、-2.961、-6.310,P<0.05)。多因素Logistic回归分析显示,纤维蛋白(原)降解产物(OR=0.947,95%CI:0.923~0.973)、胃底静脉曲张(重度)(OR=30.502,95%CI:10.006~92.978)为ACLF并发上消化道出血的独立危险因素。结论临床应重视纤维蛋白(原)降解产物增多,以及重度胃底静脉曲张的ACLF患者,及时进行干预以尽量避免患者并发上消化道出血。

Objective To investigate the risk factors of acute-on-chronic liver failure(ACLF)complicated with upper gastrointestinal hemorrhage.Methods A total of 154 patients with ACLF were enrolled in the First Affiliated Hospital of Xinjiang Medical University from 2010 to 2018.According to the upper gastrointestinal bleeding or not,they were divided into bleeding group(54 cases)and no bleeding group(100 cases).Patient's clinical,laboratory and imaging examination data were collected,and multivariate Logistic regression analysis was used for analysis of the risk factors of ACLF complicated with upper gastrointestinal bleeding.Results Univariate analysis showed that there were significant differences in 9 indexes between bleeding group and no bleeding group,including complications(encephalopathy,hepatorenal syndrome),varicose degree of gastric fundus(severe),percentage of neutrophils,D-dimer,fibrin/fibrinogen degradation products(FDP),total protein,procalcitonin,portal vein width,IL-6(χ^2=8.035,6.404,48.060,Z=-3.391,-5.017,-5.118,-3.698,-2.367,-2.961,-6.310,P<0.05).Multivariate Logistic regression analysis showed that FDP(OR=0.947,95%CI=0.923-0.973)and varicose degree of gastric fundus(severe)(OR=30.502,95%CI=10.006-92.978)were risk factors for ACLF complicated with upper gastrointestinal bleeding.Conclusions It should be paid attention to the increase of FDP and severe gastric varices in ACLF patients,in order to avoid upper gastrointestinal bleeding.