肝硬化消化道出血伴肝性脑病的危险因素分析

Analysis of risk factors of hepatic encephalopathy associated with gastrointestinal hemorrhage in patients with liver cirrhosis

目的:研究肝硬化消化道出血伴肝性脑病(HE)的发病率、死亡率及相关危险因素。方法:回顾性分析2020年1月至2020年8月沈阳市第六人民医院收治的99例肝硬化伴消化道出血患者的临床资料,根据是否伴有HE分为观察组和对照组。通过对一般资料、生化指标、腹部超声、临床情况进行单因素分析统计,选出有统计学差异的指标(P<0.05),再进行二元Logistic多因素分析,得出肝硬化消化道出血伴HE的发病率、死亡率及相关危险因素。结果:在收集的99例肝硬化消化道出血患者中,有34例伴有HE纳入观察组,其余65例纳入对照组。观察组患者死亡率23.53%,是对照组患者死亡率(4.62%)的5倍。单因素分析结果显示,AST、TBIL、总蛋白、PT、PTA、治疗方式,在观察组和对照组对比中具有统计学差异(P<0.05)。二元Logistic多因素分析结果显示AST(b=0.011,or=1.011)、PTA(b=-0.03,or=0.970)、总蛋白(b=0.081,or=1.084)、治疗方式(b=1.003,or=2.725)与肝硬化消化道出血合并HE具有显著相关性。内科保守治疗HE发病率17.77%,TIPS治疗33.33%,内镜下止血治疗50%。结论:本次研究观察到HE在肝硬化消化道出血患者中的发病率为34.34%,死亡率23.53%。其总蛋白含量越高、AST越高及PTA越低越容易合并HE。在治疗方式中提示内镜下止血治疗更容易合并HE。

Objective:To study the incidence rate, mortality and risk factors of hepatic encephalopathy secondary to gastrointestinal hemorrhage in cirrhosis.Methods:The clinical data of 99 patients with liver cirrhosis and gastrointestinal bleeding in Shenyang Sixth People’s Hospital from January to August 2020 were retrospective analyzed. According to the diagnosis of hepatic encephalopathy, they were divided into observation group and control group. By using single factor statistical analysis method, the general data, laboratory results, abdominal ultrasound and clinical situation were analyzed to get the indicators with statistical difference(P<0.05). Then logistic regression analysis method was selected to analysis these statistically different indicators. Then binary logistic multivariate analysis was performed to obtain the incidence, mortality and related risk factors of liver cirrhosis gastrointestinal bleeding with HE. Results:Among 99 patients with liver cirrhosis and gastrointestinal bleeding, 34 patients with hepatic encephalopathy were included in the observation group, and the remaining 65 patients were included in the control group. The mortality of the observation group was 23.53%, which was 5 times of that of the control group(4.62%). The results of univariate analysis showed that AST, TBIL, total protein, PT, PTA, and treatment methods were statistically different between the observation group and the control group(P<0.05). Binary logistic multivariate analysis showed that Ast(b=0.011,or=1.011), PTA(b=-0.03,or=0.970), total protein(b=0.081,or=1.084) and treatment methods(b=1.003,or=2.725) were significantly correlated with hepatic encephalopathy in patients with cirrhosis and gastrointestinal hemorrhage. Conclusion:The incidence rate of hepatic encephalopathy in patients with cirrhosis and gastrointestinal bleeding was 34.34%, and the mortality rate was 23.53%. The higher total protein content, the higher AST and the lower PTA, the more prone to hepatic encephalopathy. The incidence rate of incidence of hepatic encephalopathy in conservative treatment group was 17.77%,the incidence rate of TIPS treatment group was 33.33%,the incidence rate of endoscopic hemostasis group was 50%,endoscopic hemostasis treatment was more likely to combine with hepatic encephalopathy.