聚桂醇联合组织胶治疗肝硬化F3型食管静脉曲张破裂出血影响因素分析

Analysis of Influencing Factors of Lauromacrogol Combined with Tissue Glue in the Treatment of Esophageal Variceal Bleeding of F3 Type in Patients with Liver Cirrhosis

目的探讨聚桂醇联合组织胶治疗肝硬化F3型食管静脉曲张破裂出血(EVB)的影响因素。方法选取医院消化内镜科2019年5月至2022年5月收治的行内镜下聚桂醇联合组织胶注射治疗的肝硬化F3型EVB患者68例,根据患者是否发生再出血不良预后事件分为正常组(44例)和出血组(24例)。对患者临床资料行单因素分析。取单因素分析结果中有统计学意义的因素进行多因素Logistic回归分析,预测再出血事件的独立影响因素。结果68例患者中,再出血率为35.29%。单因素分析结果提示,出血组国际标准化比值(INR)>1.5;门静脉右支直径(RVD)<8.5 mm的患者占比、终末期肝病模型(MELD)评分、4因子的纤维化指数(FIB4)及总胆红素(TBiL)水平均显著高于正常组(P<0.05),凝血酶原活动度(PTA)、血钠水平、血白蛋白水平均显著低于正常组(P<0.05);EVB出血量、肝功能Child-Pugh等级分布,两组间差异有统计学意义(P<0.05)。Logistic回归分析结果提示,INR>1.5、RVD<8.5 mm、MELD评分、FIB4及PTA为聚桂醇联合组织胶治疗后再出血发生的独立危险因素(P<0.05),而血钠水平、血白蛋白水平是预后保护因素(P<0.05)。结论内镜下聚桂醇联合组织胶治疗肝硬化F3型EVB再出血不良预后与患者肝功能减弱及凝血功能障碍密切相关,或可通过调节患者的PTA、血钠水平、血白蛋白水平等预防再出血事件的发生。

Objective To investigate the influencing factors of lauromacrogol combined with tissue glue in the treatment of esophageal variceal bleeding(EVB)of F3 type in patients with liver cirrhosis.Methods A total of 68 patients with liver cirrhosis and EVB of F3 type receiving endoscopic injection treatment of lauromacrogol combined with tissue glue in the Department of Digestive Endoscopy of the hospital from May 2019 to May 2022 were selected and divided into the normal group(44 cases)and the bleeding group(24 cases)according to whether the adverse prognostic event of rebleeding occurred.A univariate analysis was carried out for the patients'clinical data.The factors with statistical significance in the univariate analysis were collected for the multivariate Logistic regression analysis to predict the independent influencing factors of rebleeding event.Results Among the 68 patients,the rebleeding rate was 35.29%.The results of univariate analysis showed that the proportions of patients with the international normalized ratio(INR)>1.5 and right portal vein diameter(RVD)<8.5 mm,the model for end-stage liver disease(MELD)score,fibrosis 4 score(FIB4)and total bilirubin(TBiL)level in the bleeding group were significantly higher than those in the normal group(P<0.05),and the prothrombin time activity(PTA),serum sodium and serum albumin levels in the bleeding group were significantly lower than those in the normal group(P<0.05).EVB amount distribution,Child-Turcotte-Pugh Classification distribution in the two groups were significantly different(P<0.05).The results of Logistic regression analysis showed that INR>1.5,RVD<8.5 mm,MELD score,FIB4 and PTA were the independent risk factors for rebleeding after treatment with lauromacrogol combined with tissue glue(P<0.05),while serum sodium and serum albumin levels were the prognostic protective factors(P<0.05).Conclusion The poor prognosis of rebleeding in patients with liver cirrhosis and EVB of F3 type treated with endoscopic lauromacrogol combined with tissue glue is closely related to weakened liver function and coagulation dysfunction,we may prevent the occurrence of rebleeding event by regulating patients'PTA,serum sodium and serum albumin levels.