慢性乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血的危险因素分析

摘要/Abstract

摘要： 目的分析慢性乙型肝炎(CHB)肝硬化并发食管胃底静脉曲张破裂出血(EGVB)的危险因素,为积极做好一级预防和干预治疗提供参考依据。方法选取2021年1月—2023年12月海安市人民医院收治的CHB肝硬化伴食管胃底静脉曲张(EGV)患者274例,根据因EGVB入院或住院期间是否发生EGVB将研究对象分为EGVB组(n=55)和非EGVB组(n=219);收集研究对象的基线资料、血清学和影像学指标。单因素和Logistic多因素分析CHB肝硬化伴EGV患者发生EGVB的影响因素和独立危险因素,绘制受试者工作曲线(ROC)分析各独立影响因素的预测价值。结果 274例CHB肝硬化伴EGV患者中有55例发生EGVB,发生率为20.07%。EGVB组的肝硬化病程、意外创伤史、门静脉血栓(PVT)病史、高敏-C反应蛋白(hs-CRP)、红色征阳性、门静脉内径(PVD)、肝硬度值(LSM)、Child-Pugh分级C级和终末期肝病模型(MELD)评分为(14.35±4.38)年、16.36%、23.64%、11.07mg/L、83.64%、(17.52±2.48)mm、(20.47±3.65)kPa、47.27%和(19.58±2.46)分,均高于非EGVB组的(12.46±4.15)年、5.02%、8.68%、9.16 mg/L、31.51%、(14.35±2.07)mm、(15.39±2.84)kPa、19.63%和(16.28±2.4)分,EGVB组的非选择性β受体阻滞剂(NSBB)治疗史和门静脉血流峰值(PPV)为29.10%和0.13m/s,低于非EGVB组的19.63%和0.17m/s,差异均有统计学意义(t/χ²=5,263,3.482,3.618,5.068,6.127,7.629,7.314,4.576,7.136,3.482,4.359,均P<0.05)。logistics回归分析显示,红色征阳性、PVD和LSM升高、Child-Pugh分级C级为CHB肝硬化患者发生EGVB的独立危险因素(95%CI为3.126～9.483、3.457～11.296、2.653～7.527、1.735～6.428,OR=4.715、5.283、4.129、3.176,均P<0.05);NSBBs治疗史是保护因素(95%CI为1.275～5.013,OR=2.461,P<0.05)。ROC分析显示,NSBB治疗史、红色征阳性、PVD和LSM升高、Child-Pugh分级C级的曲线下面积(AUC)分别为0.702、0.827、0.851、0.784和0.735,敏感度为72.72%、81.82%、87.27%、74.55%、83.64%,特异度为70.91%、89.09%、83.64%、80.00%、78.18%(均P<0.01)。结论 NSBB治疗史、红色征阳性、PVD和LSM升高、Child-Pugh分级C级是CHB肝硬化患者发生EGVB的影响因素。

关键词: 慢性乙型肝炎, 肝硬化, 食管胃底静脉曲张破裂出血, 危险因素, 预防措施

Abstract: Objective To analyze the risk factors of esophageal variceal bleeding (EGVB) complicated with chronic hepatitis B (CHB) cirrhosis, and to provide reference for primary prevention and intervention treatment.Methods A total of 274 CHB cirrhosis patients with esophageal and gastric varices (EGV) admitted to the People’s Hospital of Hai’an City from January 2021 to December 2023 were involved in the study. According to whether EGVB occurred during admission or hospitalization, the subjects were divided into EGVB group (n=55) and non-EGVB group (n=219). Baseline data, serological and imaging indicators were collected. Univariate and multivariate logistic analysis were conducted to analyze the influencing factors and independent risk factors of EGVB in patients with CHB cirrhosis and EGV. The predictive value of each independent influencing factor was analyzed by receiver operating curve (ROC).Results EGVB occurred in 55 of 274 CHB cirrhosis patients with EGV (20.07%). The duration of cirrhosis, history of accidental trauma, history of portal vein thrombosis (PVT), hypersensitivity C-reactive protein (hs-CRP), positive red sign, portal vein diameter (PVD), liver hardness value (LSM), Child-Pugh grade C and model of end-stage liver disease (MELD) scores in EGVB group were 14.35±4.38 years, 16.36%, 23.64%, 11.07 mg/L, 83.64%, 17.52±2.48 mm, 20.47±3.65 kPa, 47.27% and 19.58±2.46 min respectively. They were higher than that in the non-EGVB group (12.46±4.15 years, 5.02%, 8.68%, 9.16 mg/L、31.51%、14.35±2.07 mm, 15.39±2.84 kPa, 19.63% and 16.28±2.4 min). The non-selective β-blocker (NSBB) treatment history and portal blood flow peak (PPV) in EGVB group were 29.10% and 0.13 m/s, which were lower than those in non-EGVB group (19.63% and 0.17 m/s). The above differential analyses all have statistical differences (t/χ²= 5,263, 3.482, 3.618, 5.068, 6.127, 7.629, 7.314, 4.576, 7.136, 3.482, 4.359, all P<0.05). Logistics regression analysis showed that positive red sign, elevated PVD and LSM, and Child-Pugh grade C were independent risk factors for EGVB in patients with CHB cirrhosis (95%CI 3.126-9.483, 3.457-11.296, 2.653-7.527, 1.735-6.428, 95%CI 3.126-9.483, 3.457-11.296, 2.653-7.527, 1.735-6.428). OR=4.715, 5.283, 4.129, 3.176, all P<0.05); Treatment history of NSBBs was a protective factor (95%CI 1.275-5.013, OR=2.461, P<0.05). ROC analysis showed that the area under the curve (AUC) of NSBB treatment history, positive red sign, elevated PVD and LSM, and Child-Pugh grade C were 0.702, 0.784, 0.827, 0.851 and 0.735, respectively. The sensitivity was 72.72%, 81.82%, 87.27%, 74.55%, 83.64%, and the specificity was 70.91%, 89.09%, 83.64%, 80.00%, 78.18% (all P<0.01).Conclusion NSBB treatment history, positive red sign, elevated PVD and LSM, and Child-Pugh grade C are the influencing factors for EGVB in patients with CHB cirrhosis.

Key words: Chronic hepatitis B, Liver cirrhosis, EGVB, Risk factors, Preventive measure

贲国平, 殷荣华, 杨丽. 慢性乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血的危险因素分析[J]. 肝脏, 2025, 30(3): 330-335.

BENG Guo-ping, YIN Rong-hua, YANG Li. Risk factors of esophageal and gastric varices rupture and bleeding in chronic hepatitis B cirrhosis[J]. Chinese Hepatolgy, 2025, 30(3): 330-335.

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