辽宁地区肝硬化病因变迁及食管胃底静脉曲张出血防治现状调研

Investigation on Etiological Changes of Cirrhosis and Esophagealgastricvariceal Bleeding Control Status Quo in Liaoning Region

目的:分析辽宁地区肝硬化患者的病因特点及临床特征,探讨该地区食管胃底静脉曲张的内镜筛查与防治现状。方法:回顾性收集2018年1月—2020年12月辽宁地区7家医院(沈阳市第六人民医院、本溪市第六人民医院、朝阳市第四人民医院、盘锦市传染病医院、丹东市第六人民医院、辽阳市传染病医院、阜新市传染病医院)收治的866例因肝硬化首次入院患者的临床资料。观察肝硬化患者的病因特点及临床特征,分析食管胃底静脉曲张出血的筛查与防治情况。结果:研究纳入的866例肝硬化患者中,代偿性肝硬化358例(41.34%),失代偿性肝硬化508例(58.66%);其中慢性乙型肝炎608例(70.21%),酒精性肝炎84例(9.70%),丙型肝炎74例(8.55%)。在代偿期患者中,106例(29.61%)行内镜检查,出血高风险静脉曲张患者69例,其中27例行内镜治疗,3例行介入治疗;失代偿期患者中,396例(77.95%)行内镜检查,105例行内镜治疗,31例行介入治疗。内镜筛查率从2018年的53.46%增加至2020年的62.22%,提高了8.76%;不同年份曲张伴出血患者在进行内镜治疗、介入治疗及NSBB治疗方案的选择上,差异无统计学意义(P>0.05)。结论:慢性乙型肝炎仍然是辽宁地区肝硬化的最主要病因,其次是酒精性肝炎和丙型肝炎。该地区食管胃底静脉曲张的内镜筛查比例逐年提高,但一级预防及再出血防治仍存在不足。

Objective:To analyze the etiological and clinical characteristics of patients with cirrhosis in Liaoning region,and discuss the status quo of endoscopic screening and control of esophagealgastricvariceal bleeding in this region.Method:The clinical data of 866 patients admitted for the first time due to cirrhosis from January 2018 to December 2020 in 7 hospitals in Liaoning region(the Sixth People's Hospital of Shenyang,the Sixth People's Hospital of Benxi,the Fourth People's Hospital of Chaoyang,Panjin Infectious Diseases Hospital,the Sixth People's Hospital of Dandong,Liaoyang Infectious Diseases Hospital,Fuxin Infection Diseases Hospital)were retrospectively collected.The etiological and clinical characteristics of patients with cirrhosis were observed,and the screening and control situation of esophagealgastricvariceal bleeding were analyzed.Result:Among the 866 patients with cirrhosis,358(41.34%)had compensatory cirrhosis and 508(58.66%)had decompensatory cirrhosis.Among them,608 cases(70.21%)were chronic hepatitis B,84 cases(9.70%)were alcoholic hepatitis and 74 cases(8.55%)were hepatitis C.Among the compensatory patients,106 cases(29.61%)underwent endoscopy,and 69 cases patients with high risk of varices bleeding,of which 27 cases received endoscopic treatment and 3 cases received interventional therapy.Among the decompensatory patients,396 cases(77.95%)underwent endoscopy,of which 105 cases underwent endoscopic treatment and 31 cases underwent interventional therapy.The rate of endoscopic screening increased from 53.46% in 2018 to 62.22% in 2020,an increase of 8.76%.There was no significant difference in endoscopic therapy,interventional therapy and NSBB therapeutic regimen choice among patients with varices complicated with bleeding in different years(P>0.05).Conclusion:Chronic hepatitis B is still the leading cause of cirrhosis in Liaoning region,followed by alcoholic hepatitis and hepatitis C.The proportion of endoscopic screening for esophageal-gastric varices in this region is increasing year by year,but primary prevention and rebleeding control are still insufficient.