宁夏地区肝硬化门静脉高压食管胃底静脉曲张出血防治现状的多中心研究

Current status of prevention and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension patients in Ningxia region:a multicenter study

目的探讨宁夏地区肝硬化门静脉高压食管胃底静脉曲张出血的防治现状。方法采用回顾性描述性研究方法。收集2018年1月至2020年12月宁夏地区21家医疗中心收治的820例(宁夏回族自治区人民医院85例、宁夏回族自治区第五人民医院73例、吴忠市人民医院59例、青铜峡市人民医院52例、固原市人民医院50例、固原市原州区人民医院47例、银川市第二人民医院47例、宁夏医科大学总医院40例、同心县人民医院40例、银川市第一人民医院35例、宁夏回族自治区第三人民医院34例、中卫市人民医院32例、灵武市人民医院30例、吴忠市新区医院30例、盐池县人民医院30例、宁夏回族自治区中医研究院29例、石嘴山市第二人民医院28例、石嘴山市第一人民医院25例、海原县人民医院21例、彭阳县人民医院20例、隆德县人民医院13例)肝硬化门静脉高压病人的临床资料;男538例,女282例;年龄为(56±13)岁。观察指标:(1)肝硬化门静脉高压病人的临床特征。(2)肝硬化门静脉高压食管胃底静脉曲张出血防治总体情况。(3)不同等级医院肝硬化门静脉高压食管胃底静脉曲张出血防治情况。正态分布的计量资料以x±s表示。计数资料以绝对数或率表示,组间比较采用χ^(2)检验。结果(1)肝硬化门静脉高压病人的临床特征:820例肝硬化门静脉高压病人中,代偿期271例,失代偿期549例。271例代偿期病人中,男183例,女88例;年龄为(53±12)岁;汉族185例,回族85例,其他民族1例;肝硬化病因为乙型病毒性肝炎211例,酒精性肝病4例,丙型病毒性肝炎8例,其他48例;肝功能Child-Pugh A级235例,36例资料缺失。549例失代偿期病人中,男355例,女194例;年龄为(57±14)岁;汉族373例,回族174例,其他民族2例;肝硬化病因为乙型病毒性肝炎392例,酒精性肝病33例,丙型病毒性肝炎10例,其他114例;肝功能Child-Pugh A级80例,B级289例,C级170例,10例资料缺失。(2)肝硬化门静脉高压食管胃底静脉曲张出血防治总体情况:271例代偿期病人中,38例行非选择性β受体阻滞剂(NSBB)药物治疗,16例行内镜治疗,6例行介入治疗。549例失代偿期病人中,68例行NSBB药物治疗,46例行内镜治疗,28例行介入治疗。(3)不同等级医院肝硬化门静脉高压食管胃底静脉曲张出血防治情况:271例代偿期病人中,181例来源于三级医院,其中28例行NSBB药物治疗,15例行内镜治疗,6例行介入治疗;90例来源于二级医院,其中10例行NSBB药物治疗,1例行内镜治疗。二级医院与三级医院采用NSBB预防食管胃底静脉曲张出血情况比较,差异无统计学意义(χ^(2)=0.947,P>0.05),采用内镜治疗预防食管胃底静脉曲张出血情况比较,差异有统计学意义(χ^(2)=5.572,P<0.05)。549例失代偿期病人中,309例来源于三级医院,其中22例行NSBB药物治疗,29例行内镜治疗,22例行介入治疗;240例来源于二级医院,其中46例行NSBB药物治疗,17例行内镜治疗,6例行介入治疗。二级医院与三级医院采用NSBB及介入治疗预防食管胃底静脉曲张出血情况比较,差异均有统计学意义(χ^(2)=18.065,5.956,P<0.05)。结论宁夏地区肝硬化门静脉高压病人行预防出血治疗的比例较低。对于代偿期肝硬化病人,在二级医院行内镜治疗食管胃底静脉曲张出血比例低于三级医院。对于失代偿期肝硬化病人,在二级医院行介入治疗的比例低于三级医院,但行NSBB药物治疗比例高于三级医院。

Objective To investigate the current status of prevention and treatment of esophagogastric variceal bleeding(EVB)in cirrhotic portal hypertension patients in Ningxia region.Methods The retrospective and descriptive study was conducted.The clinical data of 820 cirrhotic portal hypertension patients who were admitted to 21 medical centers in Niangxia region from January 2018 to December 2020 were collected,including 85 cases in Ningxia Hui Autonomous Region People′s Hospital,73 cases in the Fifth People′s Hospital of Ningxia Hui Autonomous Region,59 cases in the Wuzhong People′s Hospital,52 cases in the Qingtongxia People′s Hospital,50 cases in the Guyuan People′s Hospital,47 cases in the Yuanzhou District People′s Hospital of Guyuan City,47 cases in the Yinchuan Second People′s Hospital,40 cases in the General Hospital of Ningxia Medical University,40 cases in the Tongxin People′s Hospital,35 cases in the Yinchuan First People′s Hospital,34 cases in the Third People′s Hospital of Ningxia Hui Autonomous Region,32 cases in the Zhongwei People′s Hospital,30 cases in the Lingwu People′s Hospital,30 cases in the Wuzhong New District Hospital,30 cases in the Yanchi People′s Hospital,29 cases in the Ningxia Hui Autonomous Region Academy of Traditional Chinese Medicine,28 cases in the Shizuishan Second People′s Hospital,25 cases in the Shizuishan First People′s Hospital,21 cases in the Haiyuan People′s Hospital,20 cases in the Pengyang People′s Hospital,13 cases in the Longde People′s Hospital.There were 538 males and 282 females,aged(56±13)years.Observation indicators:(1)clinical charac-teristics of cirrhotic portal hypertension patients;(2)overall prevention and treatment of EVB in cirrhotic portal hypertension patients;(3)prevention and treatment of EVB in cirrhotic portal hypertension patients from different grade hospitals.Measurement data with normal distribution were represented as Mean±SD.Count data were described as absolute numbers,and comparison between groups was analyzed using the chi-square test.Results(1)Clinical characteristics of cirrhotic portal hypertension patients:of 820 cirrhotic portal hypertension patients,271 cases were in compensated stage and 549 cases were in decompensated stage.Of the 271 cases in compensated stage,there were 183 maels and 88 females,aged(53±12)years.There were 185 Han people,85 Hui people and 1 case of other ethic group.The etiological data of liver cirrhosis showed 211 cases of viral hepatitis B,4 cases of alcoholic liver disease,8 cases of viral hepatitis C,and 48 cases of other etiology.There were 235 cases of Child-Pugh grade A and 36 cases lack of data.Of the 549 cases in decompensated stage,there were 355 males and 194 females,aged(57±14)years.There were 373 Han people,174 Hui people and 2 cases of other ethic group.The etiological data of liver cirrhosis showed 392 cases of viral hepatitis B,33 cases of alcoholic liver disease,10 cases of viral hepatitis C,and 114 cases of other etiology.There were 80 cases of Child-Pugh grade A,289 cases of grade B,170 cases of grade C and 10 cases lack of data.(2)Overall prevention and treatment of EVB in cirrhotic portal hypertension patients:of 271 patients in compensated stage,38 cases received non-selectiveβ-blocker(NSBB)therapy,16 cases received endoscopic treatment,6 cases received interventional therapy.Of 549 patients in decompensated stage,68 cases received NSBB therapy,46 cases received endoscopic treatment,28 cases received interventional therapy.(3)Prevention and treatment of EVB in cirrhotic portal hypertension patients from different grade hospitals:of 271 patients in compensated stage,181 cases came from tertiary hospitals,of which 28 cases received NSBB therapy,15 cases received endoscopic treatment,6 cases received interventional therapy.Ninety cases came from secondary hospitals,of which 10 cases received NSBB therapy,1 cases received endoscopic treatment.There was no significant difference in NSBB for prevention of EVB between tertiary and secondary hospitals(χ^(2)=0.947,P>0.05),while there was a significant difference in endoscopic treatment for prevention of EVB between tertiary and secondary hospitals(χ^(2)=5.572,P<0.05).Of 549 patients in decompensated stage,309 cases came from tertiary hospitals,of which 22 cases received NSBB therapy,29 cases received endoscopic treatment,22 cases received interventional therapy.Two hundreds and fourty cases came from secondary hospitals,of which 46 cases received NSBB therapy,17 cases received endoscopic treatment,6 cases received interven-tional therapy.There were significant differences in NSBB and interventional therapy for prevention of EVB between tertiary and secondary hospitals(χ^(2)=18.065,5.956,P<0.05).Conclusions The proportion of receiving EUB prevention in cirrhotic portal hypertension in Ningxia is relatively low.For patients with compensated liver cirrhosis,the proportion of NSBB therapy and endoscopic treatment in the secondary hospitals was lower than that in tertiary hospitals.For patients with decompensated liver cirrhosis,the proportion of interventional treatment in secondary hospitals is lower than that of tertiary hospitals,but the proportion of NSBB in secondary hospitals taking is higher than that of tertiary hospitals.