老年肝癌伴肝硬化病人上消化道出血的高危因素分析

Risk factors of upper gastrointestinal bleeding in elderly patients with liver cancer complicated with cirrhosis

目的分析老年肝癌伴肝硬化病人上消化道出血的高危因素。方法回顾性分析2014~2018年我院收治的86例老年肝癌伴肝硬化病人的病例资料,按照是否出现上消化道出血将病人分为观察组和对照组,其中合并上消化道出血为观察组(n=40),无上消化道出血为对照组(n=46)。对2组病人临床资料进行比较,包括性别、年龄、BMI、家族史、吸烟史、饮酒史、病程、凝血酶原时间(prothrombin time,PT)、Hb、肝功能Child-Pugh分级、肝癌类型、伴门静脉癌栓、门静脉内径、腹水程度、食管胃底静脉曲张程度,并分析上消化道出血的高危因素。结果肝功能Child-Pugh分级、伴门静脉癌栓、腹水程度、食管胃底静脉曲张程度、PT、门静脉内径是上消化道出血的独立危险因素(P<0.05),Hb是上消化道出血的保护因素。结论老年肝癌伴肝硬化上消化道出血高危因素较多,PT、Hb、Child-Pugh分级、门静脉癌栓、腹水、食管胃底静脉曲张变化均与肝癌伴肝硬化病人上消化道出血有关。

Objective To investigate the risk factors of upper gastrointestinal bleeding in the elderly patients with liver cancer complicated with cirrhosis.Methods The clinical data of 86 elderly patients with liver cancer complicated with cirrhosis treated in our hospital from January 2014 to December 2018 were retrospectively analyzed.The patients were divided into the observation group(n=40)and control group(n=46)according to presence or absence of the upper gastrointestinal bleeding.The clinical data including gender,age,body mass index(BMI),family history,smoking history,drinking history,course of disease,prothrombin time(PT),hemoglobin(Hb),Child-Pugh classification of liver function,liver cancer type,portal vein tumor thrombus,portal vein diameter,ascites degree,as well as the esophageal and gastric varices of the two groups were compared.The risk factors of upper gastrointestinal bleeding were analyzed by Logistic regression analysis.Results Hepatic function Child-Pugh classification,portal vein tumor thrombus,ascites degree,esophageal and gastric varices,PT,and portal vein diameter were independent risk factors for upper gastrointestinal bleeding(P<0.05),while Hb was a protective factor for upper gastrointestinal bleeding.Conclusions There are many risk factors for upper gastrointestinal bleeding in the elderly patients with liver cancer and cirrhosis.PT,Hb,Child-Pugh classification,portal vein cancer thrombus,ascites,esophageal and gastric varices should be monitored so as to reduce the bleeding rate.