慢加急性肝衰竭患者上消化道出血发病率、危险因素及临床预后分析

摘要/Abstract

摘要： 目的了解慢加急性肝衰竭(ACLF)患者中上消化道出血(UGH)的影响因素及临床结局。方法选择河南省人民医院2016年2月至2021年2月ACLF患者312例,其中UGH组17例,非UGH组195例。统计学处理采用t检验、卡方检验;多因素分析ACLF患者发生UGH独立危险因素;生存率比较采用Log-Rank检验。结果 UGH组、非UGH组既往UGH史分别为52例(44.4%)、14例(7.2%),差异有统计学意义(P<0.05);UGH组、非UGH组感染分别为12例(10.2%)、5例(2.6%),差异有统计学意义(P<0.05);UGH组、非UGH组腹水分别为56例(47.8%)、47例(24.1%),差异有统计学意义(P<0.05);UGH组、非UGH组肝性脑病分别为6例(5.1%)、7例(3.6%),差异有统计学意义(P<0.05);UGH组、非UGH组MELD评分分别为(19.0±6.5)分、(11.6±5.3)分,差异有统计学意义(P<0.05);UGH组Hb、TBil、ALT、AST、INR及血清钠分别为(84.8±13.4)g/L、(52.3±9.8)μmol/L、(82.5±17.0)U/L、(73.3±15.2)U/L、(1.4±0.2)及(132.2±6.6)mmol/L,与非UGH组的(106.4±16.1)g/L、(24.5±5.6)μmol/L、(58.4±11.6)U/L、(46.2±8.9)U/L、(1.0±0.2)及(140.6±7.6)mmol/L比较,差异有统计学意义(P<0.05)。多因素分析结果提示既往UGH史、MELD评分和INR是HBV-ACLF患者发生UGH的独立预测因素(P<0.05)。随访3个月后,UGH组、非UGH组28 d生存率为66.7%(78/117)、87.7%(171/195);UGH组、非UGH组90 d生存率为40.2%(47/117)、77.9%(152/195),差异均有统计学意义(均P<0.05)。结论 ACLF患者并发UGH临床预后较差,应重视患者既往UGH史、凝血状态,早期临床干预以避免UGH发生。

关键词: 慢加急性肝衰竭, 上消化道出血, 多因素分析

Abstract: Objective To analyze the incidence, risk factors and clinical outcome of upper gastrointestinal bleeding (UGH) in patients with acute-on-chronic liver failure (ACLF), so as to understand the mechanism of the disease and provide guidance for early clinical intervention.Methods From February 2016 to February 2021, there were 312 patients with ACLF (190 males and 122 females) were enrolled in this study with an average age of (54.1±11.0) years. According to the appearance of UGH, they were divided into UGH group (n=117, 37.5%) and non-UGH group (n=195). UGH is defined as hematemesis, black stool or UGH observed under electronic gastroscope. T-test and Chi-square test was used for statistical comparison according to the types of data; Multivariate analysis was applied to explore the independent risk factors of UGH in ACLF patients. The survival rate was compared by Log-Rank test.Results Fifty-two cases (44.4%) in UGH group and 14 cases (7.2%) in non-UGH group has previous UGH history (P<0.05). Twelve cases (10.2%) in UGH group and 5 cases (2.6%) in non-UGH group had infection (P<0.05). Fifty-six cases (47.8%) in UGH group and 47 cases (24.1%) in non-UGH group had ascites (P<0.05). Six cases (5.1%) in UGH group and 7 cases (3.6%) in non-UGH group had hepatic encephalopathy (P<0.05). The MELD scores of UGH group and non-UGH group were (19.0±6.5) points and (11.6±5.3) points, respectively, with statistically significant difference (P<0.05). The levels of hemoglobin (Hb), total bilirubin (TBil), alanine aminotransferase (ALT), Aspartate aminotransferase (AST), international normalized ratio (INR) and serum sodium in UGH group were (84.8±13.4) g/L, (52.3±9.8) μmol/L, (82.5±17.0) U/L, (73.3±15.2) U/L, (1.4±0.2) and (132.2±6.6) mmol/L, respectively, which were significantly different when compared with those of [(106.4±16.1) g/L, (24.5±5.6) μmol/L, (58.4±11.6) U/L, (46.2±8.9) U/L, (1.0±0.2) and (140.6±7.6) mmol/L, respectively, in non-UGH group (P<0.05). The above-mentioned difference data were then taken as independent variables for multivariate analysis for the risk factors of UGH in ACLF patients. The Results suggested that previous UGH history, MELD score and INR were independent predictors of bleeding in HBV-ACLF patients (P<0.05). All patients were followed up for 3 months, and the endpoint was ACLF-related death. The 28-day and 90-day survival rates of UGH group (66.7% and 40.2%) were significantly lower than those of non-UGH group (87.7% and 77.9%) (all P<0.05).Conclusion The clinical prognosis of ACLF patients complicated with UGH is poor. In clinical practice, attention should be paid to patient’s with past UGH history and poor coagulation state. Early clinical intervention should be taken to avoid the occurrence of UGH.

Key words: Acute-on-chronic liver failure, Upper gastrointestinal hemorrhage, Multivariate analysis

张霞, 赵子瑜, 李敏. 慢加急性肝衰竭患者上消化道出血发病率、危险因素及临床预后分析[J]. 肝脏, 2022, 27(6): 672-674.

ZHANG Xia, ZHAO Zi-yu, LI Min. Incidence, risk factors and clinical prognosis of upper gastrointestinal hemorrhage in patients with acute-on-chronic liver failure[J]. Chinese Hepatolgy, 2022, 27(6): 672-674.

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