肝硬化伴食管胃静脉曲张患者内镜治疗后出血的危险因素分析

Risk factors of rebleeding after endoscopic treatment for esophagogastric varices in liver cirrhosis patients

目的探讨肝硬化伴食管胃静脉曲张患者行内镜治疗后的出血率及出血相关的危险因素。方法回顾性分析2018年12月—2021年6月复旦大学附属闵行医院消化内科收治的因肝硬化并食管胃静脉曲张首次行内镜下治疗的住院患者的临床资料;根据治疗后随访期间是否出血分为出血组和未出血组,比较两组间的临床特征、实验室和影像检查结果、血流动力学参数以及内镜治疗情况的差异;并采用Cox回归模型探讨静脉曲张内镜治疗后出血的独立危险因素。结果共纳入75例患者,其中15例(20%)治疗后随访期间有出血。出血组和未出血组比较,其中内镜治疗前有消化道出血的54例患者中14例出现治疗后出血,出血率25.93%(P=0.04);合并有门静脉血栓24例,治疗后出血8例,出血率33.33%(P=0.048);乙型肝炎肝硬化患者35例,有11例出现治疗后出血,出血率31.43%(P=0.021);Child A级24例,治疗后出血4例,Child B级47例,治疗后出血8例,Child C级4例,治疗后出血3例(P=0.018);内镜治疗前有消化道出血、门静脉血栓、乙型肝炎肝硬化、Child-Pugh分级是内镜下治疗后出血的危险因素。Cox回归分析显示,Child-Pugh分级(95%CI=1.273~12.879,HR=4.0487,P=0.018)是静脉曲张内镜治疗后随访期间出血的独立危险因素。结论Child-Pugh分级是肝硬化伴食管胃静脉曲张患者内镜治疗后出血的独立危险因素。对肝功能差的患者进行食管胃静脉曲张内镜治疗需慎重。

Objective To investigate the rebleeding rate and the risk factors of rebleeding after endoscopic treatment for esophagogastric varices in liver cirrhosis patients.Methods Retrospective analysis the clinical data of patients who with liver cirrhosis and accept esophageal variceal ligation and/or gastric variceal obliteration treatment for the first time from June 2018 to June 2021,and hospitalized in the Department of Gastroenterology of Minhang Hospital,Fudan University.According to whether there was bleeding during the follow-up period after treatment,they were divided into bleeding group and non bleeding group.The clinical features,laboratory results,imaging findings,hemodynamic parameters and endoscopic treatment were compared between the two groups.Cox regression model was used to explore the independent risk factors of bleeding after endoscopic treatment of varices.Results A total of 75 patients were included,of which 15(20%)had bleeding during the follow-up after treatment.Compared with the non bleeding group,14 of the 54 patients who with gastrointestinal bleeding before endoscopic treatment had bleeding after treatment,the bleeding rate was 25.93%,P=0.04.There were 24 cases complicated with portal vein thrombosis,while 8 cases were bleeding after treatment,the bleeding rate was 33.33%,P=0.048.In 35 cases of cirrhosis after hepatitis B,11 cases had bleeding after treatment,the bleeding rate was 31.43%,P=0.021.And 24 cases of child a,4 cases of bleeding after treatment,47 cases of Child B,8 cases of bleeding after treatment,4 cases of child C,3 cases of bleeding after treatment,P=0.018.Gastrointestinal bleeding occurred before endoscopic treatment,the portal vein thrombosis,cirrhosis after hepatitis B and Child-Pugh are risk factors for bleeding after endoscopic treatment,the difference between the two groups was statistically significant.Cox regression analysis showed that Child-Pugh grade(95%CI=1.273~12.879,HR=4.0487,P=0.018)was an independent risk factor for bleeding during follow-up after endoscopic treatment of varices.Conclusion Child Pugh grade is an independent risk factor for bleeding after endoscopic treatment in patients with liver cirrhosis and esophagogastric varices.Endoscopic treatment for gastroesophageal varices in patients who with poor liver function should be cautious.