肝硬化患者行内镜下套扎治疗后再出血的预测因素分析

摘要/Abstract

摘要： 目的探究肝硬化患者食管静脉曲张套扎治疗(EVL)后12个月内食管静脉曲张再出血(EVRB)的预测因素。方法收集2009年1月至2012年1月首都医科大学附属北京友谊医院收治的内镜下证实为食管静脉曲张出血(EVB)并行EVL治疗的首次出血的肝硬化患者120例,12个月内未再出血组患者73例,再出血组患者47例,分析两组患者相关资料。建立COX回归方程:h(t, X)=h₀(t)exp(0.053X₁+0.888X₆)(X₁=年龄,X₂=CTP分级),两组之间计量资料的比较采用独立样本t检验、非参数检验,计数资料的比较采用χ²检验;利用COX回归确定独立危险因素并建立COX模型。结果未再出血组患者的平均年龄为51.7岁,血红蛋白(Hb)平均为82.2 g/L,血清白蛋白(Alb)平均为30.9 g/L,再出血组患者的平均年龄为55.5岁, Hb平均为74.0 g/L,Alb为29.0 g/L。年龄、Hb、Alb、Child-Pugh分级(CTP分级)、腹水、非肿瘤性内脏静脉血栓、输血需求和门静脉宽度在两组患者中差异有统计学意义(P<0.05)。进一步多因素分析发现年龄和CTP分级是EVL术后再出血的独立预测因素,回归方程有统计学意义(χ²=21.417, P<0.01)。结论年龄、Hb、Alb、CTP分级、腹水、非肿瘤性内脏静脉血栓、输血需求和门静脉宽度是肝硬化患者首次EVB经EVL治疗后12个月内EVRB的预测因素。其中年龄和CTP分级为EVRB的独立预测因素。

关键词: 肝硬化, 食管静脉曲张出血, 内镜下套扎, 再出血

Abstract: Objective The aim of the study was to investigate predictive factors of esophageal variceal rebleeding (EVRB) within 12 months after initial endoscopic variceal ligation (EVL) treatment in patients with cirrhosis. Methods A total of 120 cirrhotic patients with esophageal variceal bleeding (EVB) treated with EVL treatment for the first time were retrospectively analyzed, who were admitted to our hospital between January 2009 and January 2012. The 120 patients were followed up for 12 months. Among these patients, 73 (60.83%) patients without rebleeding and 47 (39.17%) patients with recurrent hemorrhage within 12 months were enrolled as the non-rebleeding group and rebleeding group, respectively. Differences between 2 groups were estimated using independent samples t-test and non-parametric test for continuous variables, and χ² test for categorical variables, respectively. COX regression was used to identify independent risk factors and establish a COX model. Results The average age was 51.7 and 55.5 years old in non-rebleeding and rebleeding group, respectively. Mean hemoglobin (HGB) and mean albumin (Alb) level were 82.2 g/L and 30.9 g/L in non-rebleeding group, and 74.0 g/L and 29.0g/L in rebleeding group, respectively. Parameters including age, HGB, Alb, Child-Pugh (CTP) classification, ascites, non-neoplastic splanchnic vein thrombosis (SVT), requirement of blood transfusion and the width of portal vein were significant different between 2 groups (P<0.05). COX regression revealed that age and CTP classification were independent predictors for variceal rebleeding within 12 months of initial treatment. Besides, a COX regression equation was established: h(t, X)=h0(t)exp(0.053X₁+0.888X6) (X₁=age, X₂=CTP classification), which was statistically significant (χ²=21.417, P<0.001). Conclusion The study indicates that recurrent hemorrhage within 12 months after initial EVB and EVL treatment in cirrhotic patients is significantly associated with age, HGB, Alb, CTP classification, ascites, SVT, requirements of blood transfusion and the width of portal vein. Furthermore, age and CTP classification are the independent predictors of EVRB.

Key words: Liver cirrhosis;Esophageal variceal bleeding;Endoscopic variceal ligation;Rebleeding

柳金金, 丁蕊, 欧晓娟, 吴晓宁, 贾继东. 肝硬化患者行内镜下套扎治疗后再出血的预测因素分析[J]. 肝脏, 2018, 23(12): 1065-1068.

LIU Jin-jin, DING Rui, OU Xiao-juan, WU Xiao-ning, JIA Ji-dong. A clinical study on the predictors for esophageal variceal rebleeding in patients with liver cirrhosis after endoscopic variceal ligation treatment[J]. Chinese Hepatolgy, 2018, 23(12): 1065-1068.

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