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药物治疗的肝硬化食管胃静脉破裂出血患者生存影响因素分析

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摘要 目的 探讨反复消化道出血接受药物治疗的肝硬化食管胃静脉破裂出血(EVB)患者的生存影响因素。方法 收集2016年1月至2022年12月81例肝硬化食管胃静脉曲张出血并拒绝内镜治疗,仅接受药物治疗患者的临床资料。采用ROC曲线分析年龄与出血次数预测死亡的最佳截断值。采用单因素及多因素COX回归分析仅药物治疗的肝硬化EVB患者生存的影响因素。结果 ROC分析显示,年龄及消化道出血次数预测患者死亡的最佳截断值为76岁、4次。多因素COX回归分析结果显示,并发肝癌(HR=3.609,95%CI:1.688~7.718,P=0.001)、出血次数≥4次(HR=2.626,95%CI:1.095~6.299,P=0.031)是EVB患者死亡的独立危险因素,既往曾接受过内镜下治疗(HR=0.171,95%CI:0.068~0.435,P<0.001)是肝硬化EVB患者的独立保护因素。结论 并发肝癌、出血次数≥4的EVB患者有较高的死亡率,住院时需给予更积极的治疗,建议行内镜下治疗降低死亡风险。 Objective To explore the influencing factors of survival in patients with gastroesophageal varices with drug treatment after repeated gastrointestinal bleeding.Methods A retrospective study was conducted on 81 patients with esophageal and gastric variceal hemorrhage from cirrhosis admitted to our hospital from January 2016 to December 2022 who refused endoscopic therapy and only received drug therapy.The baseline information of all the patients were collected,including age,sex,etiology of cirrhosis,liver function grading(Child-Pugh grading),ascites,hepatic encephalopathy,liver cancer,esophageal and gastric varices classification(LDRf classification),and bleeding times.Receiver operating characteristic curve(ROC)was used to define the optimal cut-off values of age and bleeding times for predicting death.Univariate and multivariate COX regression models were used to analyze the factors affecting the survival of patients with gastroesophageal varices treated with drugs after repeated gastrointestinal bleeding.Results ROC analysis showed that the best cut-off value of age and gastrointestinal bleeding times to predict death was 76 years old,4 times.Multivariate COX regression model analysis results showed that complicated liver cancer[HR=3.609,95%confidence interval(95%CI)1.688~7.718,P=0.001],bleeding≥4 times(HR=2.626,95%CI:1.095~6.299,P=0.031)were independent risk factors for death in patients with EVB,and previous endoscopic therapy(HR=0.171,95%CI:0.068~0.435,P<0.001)was an independent protective factor in patients with EVB.Conclusion EVB patients complicated with liver cancer and bleeding times≥4 have a higher mortality rate.Therefore,more active treatment should be given during hospitalization,and endoscopic therapy is recommended to reduce the risk of death.
出处 《浙江临床医学》 2024年第7期1008-1010,共3页 Zhejiang Clinical Medical Journal
关键词 食管胃静脉曲张 药物治疗 内镜下治疗 危险因素 Gastroesophageal varices Drug treatment Endoscopic treatment Risk factor
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