肝硬化食管静脉曲张内镜治疗术后早期再出血的危险因素分析

Risk factors for early rebleeding after endoscopic therapy for esophageal varices in cirrhotic patients

目的探讨肝硬化食管静脉曲张破裂出血患者经内镜下套扎治疗、硬化剂治疗后早期再出血的危险因素。方法回顾性分析2017年5月—2019年5月于首都医科大学附属北京佑安医院行内镜下套扎治疗或者硬化剂治疗的153例肝硬化食管静脉曲张破裂出血患者的临床资料。根据内镜治疗后72 h~6周内有无再出血分为早期再出血组和未出血组,应用logistic回归分析,分析早期再出血的独立危险因素。正态分布的计量资料2组间比较采用t检验,非正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ2检验或Fisher精确概率法。结果早期再出血率为24.8%(38/153)。早期再出血组的Alb低于未出血组,APTT、PT高于未出血组,差异均有统计意义(P值均<0.05);男性、曲张静脉程度、红色征、门静脉血栓、腹水程度和肝功能分级在两组间差异均有统计意义(P值均<0.05)。logistic回归分析显示,伴发门静脉血栓(OR=9.781,95%CI:2.248~42.556,P=0.002)、大量腹水(OR=6.195,95%CI:1.053~36.447,P=0.044)及肝功能Child-Pugh C级(OR=6.434,95%CI:1.067~38.786,P=0.042)是早期再出血的独立危险因素;Alb(OR=0.806,95%CI:0.685~0.947,P=0.009)是早期再出血的保护因素。结论门静脉血栓、大量腹水、肝硬化Child C级及低蛋白血症是肝硬化食管静脉曲张破裂出血患者内镜治疗术后早期再出血的独立危险因素,临床上应引起足够重视。

Objective To investigate the risk factors for early rebleeding after endoscopic ligation or sclerotherapy for esophageal variceal bleeding in cirrhotic patients.Methods A retrospective analysis was performed for the clinical data of 153 cirrhotic patients with esophageal variceal bleeding who underwent endoscopic ligation or sclerotherapy in Beijing YouAn Hospital,Capital Medical University,from May 2017 to May 2019,and according to the presence or absence of rebleeding from 72 hours to 6 weeks after endoscopic therapy,the patients were divided into rebleeding group and non-rebleeding group.A logistic regression analysis was performed to investigate independent risk factors for early rebleeding.The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.Results Early rebleeding rate was 24.8%(38/153).Compared with the non-rebleeding group,the rebleeding group had a significantly lower albumin(Alb)and significantly higher activated partial thromboplastin time and prothrombin time(all P<0.05),and there were also significant differences between the two groups in proportion of male sex,degree of varicose veins,red color sign,portal vein thrombosis,severity of ascites,and liver function grade(all P<0.05).The multivariate logistic regression analysis showed that portal vein thrombosis(odds ratio[OR]=9.781,95%confidence interval[CI]:2.248-42.556,P=0.002),massive ascites(OR=6.195,95%CI:1.053-36.447,P=0.044),and Child-Pugh class C liver function(OR=6.434,95%CI:1.067-38.786,P=0.042)were independent risk factors for early rebleeding,while Alb(OR=0.806,95%CI:0.685-0.947,P=0.009)was a protective factor against early rebleeding.Conclusion Portal vein thrombosis,massive ascites,Child-Pugh C liver cirrhosis,and hypoproteinemia are independent risk factors for early rebleeding after endoscopic therapy in cirrhotic patients with esophageal variceal bleeding,which should be taken seriously in clinical practice.