肝硬化合并上消化道出血患者的危险因素分析
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摘要
目的分析90例肝硬化合并上消化道出血(UGBC)的危险因素。方法回顾性分析2015年2月至2018年2月滁州市第一人民医院收治的90例UGBC患者(研究组)、同期住院的94例肝硬化未出现上消化道出血患者(对照组)的临床资料(一般资料、血常规、凝血功能、肝功能、影像学资料等),采用多因素Logistic回归法分析UGBC的危险因素。结果 90例UGBC患者平均年龄在(63. 88±11. 24)岁,男女比率3. 74︰1(71︰19);上消化道出血病因中,食管胃底静脉曲张性出血48例(53. 33%),门静脉高压性胃病24例(26. 67%),消化性溃疡10例(11. 11%),急性胃黏膜病4例(4. 44%),混合型3例(3. 34%),其他1例(1. 11%);出血严重程度:轻度48例(53. 33%),中度35例(38. 89%),重度7例(7. 78%)。经治疗后,72 h内再出血21例(23. 33%),无死亡病例;单因素及多因素Logistic回归分析发现,男性、饮酒史、使用非甾体药物、凝血酶原时间(PT)、Child-Pugh分级、食管静脉曲张、腹水是UGBC的独立危险因素(P <0. 05),而春夏季发病为其保护因素(P <0. 05)。结论 UGBC多发于中老年男性,男性、饮酒史、使用非甾体药物、PT、Child-Pugh分级、食管静脉曲张、腹水是其发病独立危险因素,应加强对此类患者的监护。
Objective To analyze the risk factors of 90 patients with upper gastrointestinal bleeding in cirrhosis( UGBC). Methods The clinical data( general data,blood routine,coagulation function,liver function,imaging data,etc.) of 90 UGBC patients who were admitted to Chuzhou clinical college of Anhui Medical University from February 2015 to February 2018( study group) and 94 hospitalized patients with cirrhosis but without upper gastrointestinal bleeding in the same period( control group) were retrospectively analyzed. The risk factors of UGBC were analyzed by Multivariate Logistic regression. Results The mean age of the 90 patients with UGBC was( 63. 88 ± 11. 24) years old. The ratio of male to female was 3. 74 ︰ 1( 71 ︰ 19). Among the causes of upper gastrointestinal bleeding,there were 48 cases( 53. 33%) with the esophageal and gastric varices bleeding,24 cases( 26. 67%) with portal hypertensive gastropathy,10 cases( 11. 11%) with peptic ulcer,4 cases( 4. 44%) with acute gastric mucosal disease,3 cases( 3. 34%) with mixed type and 1 case( 1. 11%) with the other types. As for the severity of bleeding: there were 48 cases( 53. 33%) with mild status,35 cases( 38. 89%) with the moderate status and 7 cases( 7. 78%) with the severe status. After treatment,there were 21 cases( 23. 33%) with rebleeding within 72 h,and no dead case. Univariate and multivariate Logistic regression analysis showed that males,drinking history,non-steroidal drugs,prothrombin time( PT),Child-Pugh classification,esophageal varices and ascites were independent risk factor for UGBC( P < 0. 05),while the paroxysm in spring and summer was the protective factor( P <0. 05). Conclusion UGBC is more common in middle and old aged male. Male,drinking history,non-steroidal drugs,PT,Child-Pugh classification,esophageal varices and ascites are independent risk factors for this disease. Monitoring of such patients should be strengthened.
Objective To analyze the risk factors of 90 patients with upper gastrointestinal bleeding in cirrhosis( UGBC). Methods The clinical data( general data,blood routine,coagulation function,liver function,imaging data,etc.) of 90 UGBC patients who were admitted to Chuzhou clinical college of Anhui Medical University from February 2015 to February 2018( study group) and 94 hospitalized patients with cirrhosis but without upper gastrointestinal bleeding in the same period( control group) were retrospectively analyzed. The risk factors of UGBC were analyzed by Multivariate Logistic regression. Results The mean age of the 90 patients with UGBC was( 63. 88 ± 11. 24) years old. The ratio of male to female was 3. 74 ︰ 1( 71 ︰ 19). Among the causes of upper gastrointestinal bleeding,there were 48 cases( 53. 33%) with the esophageal and gastric varices bleeding,24 cases( 26. 67%) with portal hypertensive gastropathy,10 cases( 11. 11%) with peptic ulcer,4 cases( 4. 44%) with acute gastric mucosal disease,3 cases( 3. 34%) with mixed type and 1 case( 1. 11%) with the other types. As for the severity of bleeding: there were 48 cases( 53. 33%) with mild status,35 cases( 38. 89%) with the moderate status and 7 cases( 7. 78%) with the severe status. After treatment,there were 21 cases( 23. 33%) with rebleeding within 72 h,and no dead case. Univariate and multivariate Logistic regression analysis showed that males,drinking history,non-steroidal drugs,prothrombin time( PT),Child-Pugh classification,esophageal varices and ascites were independent risk factor for UGBC( P < 0. 05),while the paroxysm in spring and summer was the protective factor( P <0. 05). Conclusion UGBC is more common in middle and old aged male. Male,drinking history,non-steroidal drugs,PT,Child-Pugh classification,esophageal varices and ascites are independent risk factors for this disease. Monitoring of such patients should be strengthened.
引文
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[2]韩晶,毛锦娟,吴时胜,等.肝硬化上消化道出血患者并发门静脉血栓形成的危险因素[J].中华实用诊断与治疗杂志,2018,32(6):571-574.
[3]程远,兰宇,贾绮滨.特利加压素对肝硬化上消化道出血患者血流动力学的影响[J].临床和实验医学杂志,2018,17(22):2419-2422.
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[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):860-868.
[6]梁文京,符应田,黎燕锋,等.内镜下套扎联合药物注射治疗肝硬化合并上消化道出血的疗效[J].实用医学杂志,2016,32(12):2017-2019.
[7]张喜荣,黄孝静.中西医结合治疗慢性肝硬化并发急性上消化道出血的疗效分析[J].现代中西医结合杂志,2016,25(10):1074-1076.
[8]童庆华,彭涛,丁云,等.肝硬化合并上消化道出血的临床特征及预后分析[J].检验医学与临床,2017,14(17):2627-2629.
[9]杨美荣,刘斌,张国顺,等.唐山地区肝硬化并发上消化道出血的病因及临床特点分析[J].临床肝胆病杂志,2017,33(3):476-478.
[10]刘佳,谷建俐.回顾性分析肝硬化并上消化道出血的临床特征及预后危险因素[J].现代消化及介入诊疗,2018,23(1):52-54.
[11]韩丹,张韬,张跃新,等.肝硬化上消化道出血的危险因素分析[J].成都医学院学报,2016,11(1):62-64.
[12]张蕾,王勇,李华龙,等.乙型肝炎肝硬化伴上消化道出血患者医院感染因素分析[J].中华医院感染学杂志,2016,26(17):3903-3905.
[13]陈志敏,仇建成,上官惠敏,等.肝硬化患者上消化道出血危险因素与预后影响因素分析[J].中华医院感染学杂志,2015,25(19):4488-4490.
[14]武彦芳.肝硬化上消化道出血危险因素及预后影响因素分析[J].陕西医学杂志,2015,44(3):340-342.
[2]韩晶,毛锦娟,吴时胜,等.肝硬化上消化道出血患者并发门静脉血栓形成的危险因素[J].中华实用诊断与治疗杂志,2018,32(6):571-574.
[3]程远,兰宇,贾绮滨.特利加压素对肝硬化上消化道出血患者血流动力学的影响[J].临床和实验医学杂志,2018,17(22):2419-2422.
[4]张书娥.肝硬化的诊断标准和治疗方案[J].现代中西医结合杂志,2002,11(10):953-954.
[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):860-868.
[6]梁文京,符应田,黎燕锋,等.内镜下套扎联合药物注射治疗肝硬化合并上消化道出血的疗效[J].实用医学杂志,2016,32(12):2017-2019.
[7]张喜荣,黄孝静.中西医结合治疗慢性肝硬化并发急性上消化道出血的疗效分析[J].现代中西医结合杂志,2016,25(10):1074-1076.
[8]童庆华,彭涛,丁云,等.肝硬化合并上消化道出血的临床特征及预后分析[J].检验医学与临床,2017,14(17):2627-2629.
[9]杨美荣,刘斌,张国顺,等.唐山地区肝硬化并发上消化道出血的病因及临床特点分析[J].临床肝胆病杂志,2017,33(3):476-478.
[10]刘佳,谷建俐.回顾性分析肝硬化并上消化道出血的临床特征及预后危险因素[J].现代消化及介入诊疗,2018,23(1):52-54.
[11]韩丹,张韬,张跃新,等.肝硬化上消化道出血的危险因素分析[J].成都医学院学报,2016,11(1):62-64.
[12]张蕾,王勇,李华龙,等.乙型肝炎肝硬化伴上消化道出血患者医院感染因素分析[J].中华医院感染学杂志,2016,26(17):3903-3905.
[13]陈志敏,仇建成,上官惠敏,等.肝硬化患者上消化道出血危险因素与预后影响因素分析[J].中华医院感染学杂志,2015,25(19):4488-4490.
[14]武彦芳.肝硬化上消化道出血危险因素及预后影响因素分析[J].陕西医学杂志,2015,44(3):340-342.