胃癌并发出血的危险因素分析
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摘要
目的分析胃癌合并出血病人的危险因素。方法回顾收集2000~2012年期间就诊于河北医科大学第四医院的胃癌病人。根据病人发病过程中是否并发出血,将病人分为出血组和非出血组。比较两组的临床基线资料、入院时辅助检查资料、手术相关资料和住院期间的主要情况。使用Logistic回归分析胃癌合并出血的危险因素。结果累计入选病人7 919例,其中合并出血病例316例,未并发出血的胃癌病人7 603例。出血组病人男性比例高于非出血组(69.3%比60.3%,P=0.001)。与非出血组相比,出血组病人高血压、糖尿病比例高(均P<0.001)。出血组病人吸烟比例较非出血组低(32.0%比39.8%,P=0.005)。与非出血组相比,出血组病人并发梗阻的比例较高(P=0.002),两组病人合并消化道穿孔的比例相似。出血组病人入院时便潜血比例较高(P<0.001),血红蛋白、总蛋白和白蛋白水平低于对照组(均P<0.001),两组病人天冬氨酸转氨酶和丙氨酸转氨酶水平相似(均P>0.05)。两组病人在肿瘤浸润深度和肿瘤TNM分期方面存在明显差异(均P<0.05),两组病人M分期情况和术后并发症无明显差异。Logistic回归分析发现,男性、高血压、糖尿病、合并消化道穿孔、肿瘤浸润深度、肿瘤TNM分期、术前白蛋白和总蛋白水平以及入院时便潜血阳性是胃癌合并出血的危险因素(均P<0.05)。结论胃癌合并出血的危险因素包括:男性、高血压、糖尿病、合并消化道穿孔、肿瘤TNM分期、术前白蛋白和总蛋白水平以及入院时便潜血阳性。
Objective To analyze the risk factors of gastrointestinal bleeding in gastric cancer.Methods The patients with gastric cancer admitted to the Fourth Hospital of Hebei Medical University were retrospectively enrolled in this study. All the cases were divided into bleeding group and non-bleeding group according to the incidence of gastrointestinal bleeding. The baseline clinical characteristics,laboratory tests,characteristics of surgery and adverse events during hospitalization were recorded and compared between the two groups. Logistic analysis was used to investigate the risk factors of gastrointestinal bleeding in gastric cancer. Results A total of 7919 cases were enrolled,including 316 cases in the bleeding group and 7600 cases in the non-bleeding group. More male patients were in the bleeding group( 69. 3% vs. 60. 3%,P =0. 001). There were more patients with hypertention,diabetes in patients in the bleeding group( all P < 0.001). There were less smokers in the bleeding group than in the non-bleeding group( 32. 0% vs. 39. 8%,P = 0. 005). The incidence of obstruction wassignificantly higher in the bleeding group than that in the nonbleeding group( P = 0. 002),but that of perforation was similar between the two groups. The incidence of positive fecal occult blood was higher( P < 0. 001),and the levels of hemoglobin,albumin and total protein were lower in the bleeding group( all P < 0. 001). No significant difference was found in the levels of ALT and AST between two groups( both P > 0. 05). There were no significant differences in infiltration depth and TNM staging of tumor between two groups( both P < 0. 05). The results of logistic analysis revealed that male,hypertention,diabetes,perforation,infiltration depth,TNM staging,levels of albumin and total protein as well as positive fecal occult blood were risk factors for gastrointestinal bleeding in gastric cancer( all P < 0. 05). Conclusions The risk factors of gastrointestinal bleeding in gastric cancer included male,hypertention,diabetes,perforation,infiltration depth,TNM staging,levels of albumin and total protein as well as positive fecal occult blood.
Objective To analyze the risk factors of gastrointestinal bleeding in gastric cancer.Methods The patients with gastric cancer admitted to the Fourth Hospital of Hebei Medical University were retrospectively enrolled in this study. All the cases were divided into bleeding group and non-bleeding group according to the incidence of gastrointestinal bleeding. The baseline clinical characteristics,laboratory tests,characteristics of surgery and adverse events during hospitalization were recorded and compared between the two groups. Logistic analysis was used to investigate the risk factors of gastrointestinal bleeding in gastric cancer. Results A total of 7919 cases were enrolled,including 316 cases in the bleeding group and 7600 cases in the non-bleeding group. More male patients were in the bleeding group( 69. 3% vs. 60. 3%,P =0. 001). There were more patients with hypertention,diabetes in patients in the bleeding group( all P < 0.001). There were less smokers in the bleeding group than in the non-bleeding group( 32. 0% vs. 39. 8%,P = 0. 005). The incidence of obstruction wassignificantly higher in the bleeding group than that in the nonbleeding group( P = 0. 002),but that of perforation was similar between the two groups. The incidence of positive fecal occult blood was higher( P < 0. 001),and the levels of hemoglobin,albumin and total protein were lower in the bleeding group( all P < 0. 001). No significant difference was found in the levels of ALT and AST between two groups( both P > 0. 05). There were no significant differences in infiltration depth and TNM staging of tumor between two groups( both P < 0. 05). The results of logistic analysis revealed that male,hypertention,diabetes,perforation,infiltration depth,TNM staging,levels of albumin and total protein as well as positive fecal occult blood were risk factors for gastrointestinal bleeding in gastric cancer( all P < 0. 05). Conclusions The risk factors of gastrointestinal bleeding in gastric cancer included male,hypertention,diabetes,perforation,infiltration depth,TNM staging,levels of albumin and total protein as well as positive fecal occult blood.
引文
1 Brenner H,Rothenbacher D,Arndt V.Epidemiology of stomach cancer.Methods Mol Biol,2009,472:467-477.DOI:10.1007/978-1-60327-492-0_23.
2 Merabishvili VM.Analytical epidemiology of stomach cancer.Vopr Onkol,2013,59:565-570.
3章兴灿,何兰兰,张小玉,等.胃癌急性出血的临床特点及奥曲肽止血效果观察.中华临床医师杂志(电子版),2013,7:4113-4114.DOI:10.3877/cma.j.issn.1674-0785.2013.09.080.
4郑才锋.急诊胃镜治疗胃癌急性出血的临床效果及安全性分析.实用癌症杂志,2017,32:638-640.DOI:10.3969/j.issn.1001-5930.2017.04.034.
5汤兴华,刘雄,章宜兰,等.急诊内镜在消化道肿瘤病人上消化道出血中的诊疗价值.中国肿瘤临床与康复,2015,22:422-424.DOI:10.13455/j.cnki.cjcor.2015.04.13.
6 Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012.CA Cancer J Clin,2015,65:87-108.DOI:10.3322/caac.21262.
7 Washington K.7th edition of the AJCC cancer staging manual:stomach.Ann Surg Oncol,2010,17:3077-3079.DOI:10.1245/s10434-010-1362-z.
8 Hari DM,Leung AM,Lee JH,et al.AJCC Cancer Staging Manual 7th edition criteria for colon cancer:do the complex modifications improve prognostic assessment.J Am Coll Surg,2013,217:181-190.DOI:10.1016/j.jamcollsurg.2013.04.018.
9刘早红,许可葵,董月华,等.2009-2012年湖南省肿瘤登记地区胃癌的发病与死亡分析.实用预防医学,2017,24:1120-1124.DOI:10.3969/j.issn.1006-3110.2017.09.027.
10黄兴宇,韩仁强,滕支梅,等.2003-2012年江苏省胃癌发病死亡及农村地区生存情况分析.中华疾病控制杂志,2017,21:482-486.DOI:10.16462/j.cnki.zhjbkz.2017.05.013.
11李桂刚,翟玉庭,张发学,等.山东省招远市2008~2012年胃癌发病与死亡分析.中国肿瘤,2017,32:515-518.DOI:10.11735/j.issn.1004-0242.2017.07.A003.
12邵珂,田莹莹,张银铃.胃癌并上消化道出血的内镜治疗效果分析.中华肿瘤防治杂志,2016,23:185-186.DOI:10.16073/j.cnki.cjcpt.2016.s2.089.
13孙阳,李兆堂.胃癌根治术后上消化道出血的原因分析与治疗措施.世界最新医学信息文摘,2016,19:51.DOI:10.16073/j.cnki.cjcpt.2016.s2.089.
14冯小嫦.食管癌、胃癌并上消化道出血的内镜治疗效果分析.中国卫生产业,2014,32:16-17.DOI:10.16659/j.cnki.1672-5654.2014.32.025.
15徐泽宽,徐皓.胃癌根治术后消化道出血原因及处理.中国实用外科杂志,2013,33:306-308.
16高乐智,张鹏.胃癌合并大出血的手术治疗.中国社区医师(医学专业),2012,27:106-107.DOI:10.3969/j.issn.1007-614x.2012.27.101.
17陈军.胃癌合并急性大出血的诊治经验.中国实用外科杂志,2005,25:394-396.DOI:10.3321/j.issn:1005-2208.2005.07.006.
18李炜.胃癌合并急性出血36例诊治分析.中国热带医学,2011,11:884-885.DOI:10.13604/j.cnki.46-1064/r.2011.07.057.
19李忠贤.消化道急性出血的治疗分析.大家健康(学术版),2013,28:188-189.
20项丹妮,曹秀英,戚元琳.老年人胃癌伴上消化道出血112例临床特点及围手术期处理.实用癌症杂志,2000,15:58-59.
21陈权.急诊手术治疗胃癌76例的疗效分析与体会.当代医学,2012,19:123-124.DOI:10.3969/j.issn.1009-4393.2012.7.084.
22 Marmo R,Del PM,Rotondano G,et al.Mortality from nonulcer bleeding is similar to that of ulcer bleeding in high-risk patients with nonvariceal hemorrhage:a prospective database study in Italy.Gastrointest Endosc,2012,75:263-272.e1.DOI:10.1016/j.gie.2011.07.066.
2 Merabishvili VM.Analytical epidemiology of stomach cancer.Vopr Onkol,2013,59:565-570.
3章兴灿,何兰兰,张小玉,等.胃癌急性出血的临床特点及奥曲肽止血效果观察.中华临床医师杂志(电子版),2013,7:4113-4114.DOI:10.3877/cma.j.issn.1674-0785.2013.09.080.
4郑才锋.急诊胃镜治疗胃癌急性出血的临床效果及安全性分析.实用癌症杂志,2017,32:638-640.DOI:10.3969/j.issn.1001-5930.2017.04.034.
5汤兴华,刘雄,章宜兰,等.急诊内镜在消化道肿瘤病人上消化道出血中的诊疗价值.中国肿瘤临床与康复,2015,22:422-424.DOI:10.13455/j.cnki.cjcor.2015.04.13.
6 Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012.CA Cancer J Clin,2015,65:87-108.DOI:10.3322/caac.21262.
7 Washington K.7th edition of the AJCC cancer staging manual:stomach.Ann Surg Oncol,2010,17:3077-3079.DOI:10.1245/s10434-010-1362-z.
8 Hari DM,Leung AM,Lee JH,et al.AJCC Cancer Staging Manual 7th edition criteria for colon cancer:do the complex modifications improve prognostic assessment.J Am Coll Surg,2013,217:181-190.DOI:10.1016/j.jamcollsurg.2013.04.018.
9刘早红,许可葵,董月华,等.2009-2012年湖南省肿瘤登记地区胃癌的发病与死亡分析.实用预防医学,2017,24:1120-1124.DOI:10.3969/j.issn.1006-3110.2017.09.027.
10黄兴宇,韩仁强,滕支梅,等.2003-2012年江苏省胃癌发病死亡及农村地区生存情况分析.中华疾病控制杂志,2017,21:482-486.DOI:10.16462/j.cnki.zhjbkz.2017.05.013.
11李桂刚,翟玉庭,张发学,等.山东省招远市2008~2012年胃癌发病与死亡分析.中国肿瘤,2017,32:515-518.DOI:10.11735/j.issn.1004-0242.2017.07.A003.
12邵珂,田莹莹,张银铃.胃癌并上消化道出血的内镜治疗效果分析.中华肿瘤防治杂志,2016,23:185-186.DOI:10.16073/j.cnki.cjcpt.2016.s2.089.
13孙阳,李兆堂.胃癌根治术后上消化道出血的原因分析与治疗措施.世界最新医学信息文摘,2016,19:51.DOI:10.16073/j.cnki.cjcpt.2016.s2.089.
14冯小嫦.食管癌、胃癌并上消化道出血的内镜治疗效果分析.中国卫生产业,2014,32:16-17.DOI:10.16659/j.cnki.1672-5654.2014.32.025.
15徐泽宽,徐皓.胃癌根治术后消化道出血原因及处理.中国实用外科杂志,2013,33:306-308.
16高乐智,张鹏.胃癌合并大出血的手术治疗.中国社区医师(医学专业),2012,27:106-107.DOI:10.3969/j.issn.1007-614x.2012.27.101.
17陈军.胃癌合并急性大出血的诊治经验.中国实用外科杂志,2005,25:394-396.DOI:10.3321/j.issn:1005-2208.2005.07.006.
18李炜.胃癌合并急性出血36例诊治分析.中国热带医学,2011,11:884-885.DOI:10.13604/j.cnki.46-1064/r.2011.07.057.
19李忠贤.消化道急性出血的治疗分析.大家健康(学术版),2013,28:188-189.
20项丹妮,曹秀英,戚元琳.老年人胃癌伴上消化道出血112例临床特点及围手术期处理.实用癌症杂志,2000,15:58-59.
21陈权.急诊手术治疗胃癌76例的疗效分析与体会.当代医学,2012,19:123-124.DOI:10.3969/j.issn.1009-4393.2012.7.084.
22 Marmo R,Del PM,Rotondano G,et al.Mortality from nonulcer bleeding is similar to that of ulcer bleeding in high-risk patients with nonvariceal hemorrhage:a prospective database study in Italy.Gastrointest Endosc,2012,75:263-272.e1.DOI:10.1016/j.gie.2011.07.066.