乙肝肝硬化患者食管胃底静脉曲张破裂出血的危险因素分析
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摘要
目的筛选乙肝肝硬化患者食管胃底静脉曲张破裂出血的危险因素。方法选取乙肝肝硬化患者90例,食管胃底静脉曲张破裂出血患者37例为出血组,非出血组为53例,分别统计其临床资料包括年龄、性别、谷丙转氨酶(ALT)、谷草转氨酶(AST)、血小板(platelet count,PLT)、血清总胆红素(TBIL)、血清白蛋白(serum albumin,ALB)、凝血酶原活动度(PTA)、门静脉直径、脾脏直径、腹水、HCC、碱性磷酸酶(ALP)、白细胞(WBC)、血钙(Ca)15个指标首先进行单因素分析,差异有统计学意义的指标进行Logistic回归分析得出乙肝肝硬化患者并发食管胃底静脉曲张破裂出血的独立危险因素。结果单因素分析发现年龄,有无腹水、谷丙转氨酶ALT、谷草转氨酶AST、总胆红素(TBIL)、血钙、血小板(PLT)、脾脏直径和碱性磷酸酶ALP为危险因素,两组比较差异有统计学意义(P<0.05)。进一步行多因素Logistic回归分析,发现年龄、血钙、谷草转氨酶和总胆红素与乙肝肝硬化食管胃底静脉曲张破裂出血的发生呈负相关,其回归系数分别为-1.205、-1.533、-2.583和-1.733,相对危险度OR值分别为0.300、0.212、0.076和0.177,年龄、血钙、AST和TBIL是乙肝肝硬化食管胃底静脉曲张破裂出血的独立危险因素,并进行ROC曲线发现AUC值分别为0.710,0.687,0.784,0.685。结论年龄、血钙、谷草转氨酶和总胆红素是肝硬化患者发生食管静脉曲张破裂出血的独立危险因素,其中谷草转氨酶的曲线下面积值最大,其灵敏度和特异度相对较高。
Objective To screen the risk factors of esophageal and gastric varices bleeding in patients with hepatitis B cirrhosis. Methods 90 patients with hepatitis B cirrhosis, 37 patients with esophageal varices bleeding, including bleeding group, 53 patients with non-bleeding group, their general data including age, gender, alanine aminotransferase(ALT), and grass Transaminase(AST), platelet count(PLT), serum total bilirubin(TBIL), serum albumin(ALB), prothrombin activity(PTA), portal diameter, spleen diameter Ascites, HCC, alkaline phosphatase(ALP), white blood cells(WBC), and serum calcium were first analyzed by one-way analysis of variance, and logistic regression analysis was performed on the statistically significant(P<0.05) index, and the independent risk factors for esophageal varices bleeding in patients with hepatitis B cirrhosis were obtained. Results Univariate analysis revealed: age, presence or absence of ascites, alanine aminotransferase(ALT), aspartate aminotransferase(AST),total bilirubin(TBIL), blood calcium(blood Ca), platelet(PLT), spleen diameter and alkali Sex phosphatase(ALP) was a risk factor, and the difference was statistically significant(P<0.05). Further logistic regression analysis showed that age, serum calcium, aspartate aminotransferase and total bilirubin were negatively correlated with the occurrence of esophageal and gastric varices bleeding in hepatitis B cirrhosis, and the regression coefficients were-1.205,-1.533,-2.583 and-1.733, relative risk(OR values) were 0.300, 0.212, 0.076, and 0.177, respectively. Age, serum calcium, AST,and TBIL were independent risk factors for esophageal and gastric varices bleeding in patients with hepatitis B cirrhosis, and ROC curves were found for AUC. The values are 0.710, 0.687, 0.784, and 0.685, respectively. Conclusion Age, serum calcium, aspartate aminotransferase and total bilirubin are independent risk factors for esophageal varices bleeding in patients with liver cirrhosis. The area under the curve of aspartate aminotransferase is the largest, and its sensitivity and specificity are relatively high.
Objective To screen the risk factors of esophageal and gastric varices bleeding in patients with hepatitis B cirrhosis. Methods 90 patients with hepatitis B cirrhosis, 37 patients with esophageal varices bleeding, including bleeding group, 53 patients with non-bleeding group, their general data including age, gender, alanine aminotransferase(ALT), and grass Transaminase(AST), platelet count(PLT), serum total bilirubin(TBIL), serum albumin(ALB), prothrombin activity(PTA), portal diameter, spleen diameter Ascites, HCC, alkaline phosphatase(ALP), white blood cells(WBC), and serum calcium were first analyzed by one-way analysis of variance, and logistic regression analysis was performed on the statistically significant(P<0.05) index, and the independent risk factors for esophageal varices bleeding in patients with hepatitis B cirrhosis were obtained. Results Univariate analysis revealed: age, presence or absence of ascites, alanine aminotransferase(ALT), aspartate aminotransferase(AST),total bilirubin(TBIL), blood calcium(blood Ca), platelet(PLT), spleen diameter and alkali Sex phosphatase(ALP) was a risk factor, and the difference was statistically significant(P<0.05). Further logistic regression analysis showed that age, serum calcium, aspartate aminotransferase and total bilirubin were negatively correlated with the occurrence of esophageal and gastric varices bleeding in hepatitis B cirrhosis, and the regression coefficients were-1.205,-1.533,-2.583 and-1.733, relative risk(OR values) were 0.300, 0.212, 0.076, and 0.177, respectively. Age, serum calcium, AST,and TBIL were independent risk factors for esophageal and gastric varices bleeding in patients with hepatitis B cirrhosis, and ROC curves were found for AUC. The values are 0.710, 0.687, 0.784, and 0.685, respectively. Conclusion Age, serum calcium, aspartate aminotransferase and total bilirubin are independent risk factors for esophageal varices bleeding in patients with liver cirrhosis. The area under the curve of aspartate aminotransferase is the largest, and its sensitivity and specificity are relatively high.
引文
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[9]蒋彩凤,施斌,谢渭芬.血清腹水白蛋白梯度对食管胃底静脉曲张破裂出血的预测价值[J].中华消化杂志,2011,31(9):591-593.
[10]刘长珠,傅小敏,王平.彩色多普勒超声对食管胃底静脉曲张破裂出血危险性的判断价值[J].新医学,2003,34(9):542-544.
[11]罗莉丽.腹部B超对肝硬化门脉高压的诊断价值探讨[J].当代医学,2015,21(10):56-57.
[12]李朝辉,武焕弟.非侵入性检查预测肝硬化食管静脉曲张的临床研究[J].当代医学,2011,17(9):70-71.
[13]刘迎迎,任为国.Fibroscan在预测肝硬化食管静脉曲张程度及出血中的作用[J].当代医学,2014,20(1):10-12.
[14]王万鹏,冯静,许蕾,等.肝炎肝硬化患者并发食管胃底静脉曲张破裂出血的预测指标研究[J].中国全科医学,2015(22):2676-2679.
[15]孙树申,向慧玲,刘芳,等.瞬时弹性成像技术对慢性肝病患者肝硬化程度及食管胃底静脉曲张破裂出血的预测研究[J].中国全科医学,2015(33):4147-4152.
[2]中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范[J].2017,16(3):705-720.
[3] Benedeto-Stojanov Daniela, Nagorni Aleksandar, Mladenovi?Bojan, et al. Risk and causes of gastroesophageal bleeding in patients with liver cirrhosis[J].Vojnosanitetski pregled, 2007,64(9):585-589.
[4]李忠明.肝硬化食管胃底静脉曲张破裂出血相关危险因素分析[J].中国基层医药,2015,22,(1):106-108.
[5]于芝瑞,魏国喜,刘其昌,等.HBV相关肝硬化合并急性上消化道出血的危险因素分析[J].临床肝胆病杂志,2017,33(5):860-863.
[6]赵佳宫,航宇,崔祖丽.肝硬化食管胃底静脉曲张破裂出血的危险因素探究[J].中国现代药物应用,2017,11(24):52-53.
[7]林尤冠,孙龙,蔡笃雄,等.食管胃底静脉曲张破裂出血相关危险因素的分析[J].海南医学院学报,2011,17(3):352-354.
[8]吴珍萍,施莉韦,炜向华.血清-腹水白蛋白梯度预测食管-胃底静脉曲张破裂出血的风险[J].现代实用医学,2013,25(11):1238-1239.
[9]蒋彩凤,施斌,谢渭芬.血清腹水白蛋白梯度对食管胃底静脉曲张破裂出血的预测价值[J].中华消化杂志,2011,31(9):591-593.
[10]刘长珠,傅小敏,王平.彩色多普勒超声对食管胃底静脉曲张破裂出血危险性的判断价值[J].新医学,2003,34(9):542-544.
[11]罗莉丽.腹部B超对肝硬化门脉高压的诊断价值探讨[J].当代医学,2015,21(10):56-57.
[12]李朝辉,武焕弟.非侵入性检查预测肝硬化食管静脉曲张的临床研究[J].当代医学,2011,17(9):70-71.
[13]刘迎迎,任为国.Fibroscan在预测肝硬化食管静脉曲张程度及出血中的作用[J].当代医学,2014,20(1):10-12.
[14]王万鹏,冯静,许蕾,等.肝炎肝硬化患者并发食管胃底静脉曲张破裂出血的预测指标研究[J].中国全科医学,2015(22):2676-2679.
[15]孙树申,向慧玲,刘芳,等.瞬时弹性成像技术对慢性肝病患者肝硬化程度及食管胃底静脉曲张破裂出血的预测研究[J].中国全科医学,2015(33):4147-4152.