超声指标在食管胃静脉曲张破裂出血预测中的价值

发布时间：2018-07-09 12:36

本文选题：肝硬化 + 食管静脉曲张　；参考：《广东医学》2017年S1期

【摘要】：目的探讨食管胃静脉曲张破裂出血的危险因素,分析超声检查在其出血预测中的意义。方法收集肝硬化合并食管胃静脉曲张患者,彩超及临床资料齐全者370例,其中出血组153例,未出血组217例。收集患者临床及超声指标。对比两组间指标的差异。建立多因素logistic回归模型探讨食管胃静脉曲张破裂出血的危险因素。结果出血组与未出血组在年龄及性别组成方面差异无统计学意义。与未出血组相比,出血组患者腹腔积液者较多,血小板计数、Child-Pugh评分、白蛋白及凝血酶原时间均较低(P0.05)。与未出血组相比,出血组门静脉内径较宽、门静脉平均速度较慢、门静脉血流量较大、脾静脉内径较宽、胃左静脉内径较宽、脾厚度较宽(P0.05)。两组在脾静脉平均速度及脾静脉血流量方面差异无统计学意义(P0.05)。多因素logistic回归模型结果提示血小板计数(OR 0.56;95%CI 0.05~0.81;P0.001)及白蛋白(OR 0.68;95%CI 0.12~0.91;P0.001)是食管胃静脉曲张破裂出血的保护因素,Child-Pugh评分(OR 1.49;95%CI 1.33~3.14;P=0.020)、凝血酶原时间(OR 1.23;95%CI 1.01~3.17;P=0.032)均为其危险因素。超声指标中门静脉内径(OR 3.68;95%CI 2.15~8.53;P0.001)、脾静脉内径(OR 1.45;95%CI 1.04~4.98;P=0.023)、胃左静脉内径(OR 1.88;95%CI 1.04~4.78;P=0.006)以及脾厚度(OR 2.32;95%CI 1.01~5.68;P=0.001)均是食管胃静脉曲张破裂出血的独立危险因素。结论血小板计数及白蛋白是食管胃静脉曲张破裂出血的保护因素。Child-Pugh评分、凝血酶原时间、超声指标中门静脉内径、脾静脉内径、胃左静脉内径以及脾厚度均是食管胃静脉曲张破裂出血的危险因素。临床工作时需注意患者上述指标的变化,减少出血风险。
[Abstract]:Objective to investigate the risk factors of esophageal and gastric variceal bleeding and to analyze the significance of ultrasonography in predicting bleeding. Methods 370 cases of cirrhosis complicated with esophageal and gastric varices were collected, including 153 cases of bleeding group and 217 cases of non-bleeding group. The clinical and ultrasonic indexes were collected. The differences between the two groups were compared. Multivariate logistic regression model was established to study the risk factors of esophageal and gastric variceal bleeding. Results there was no significant difference in age and sex composition between bleeding group and no bleeding group. Compared with the non-bleeding group, the bleeding group had more peritoneal effusion, platelet count and Child-Pugh score, albumin and prothrombin time were lower (P0.05). Compared with the non-bleeding group, the bleeding group had wider portal vein diameter, slower average portal vein velocity, larger portal vein blood flow, wider splenic vein diameter, wider left gastric vein diameter and wider splenic thickness (P0.05). There was no significant difference in the mean velocity of splenic vein and the blood flow of splenic vein between the two groups (P0.05). The results of multivariate logistic regression model showed that platelet count (OR 0.5695 CI 0.050.81 P0.001) and albumin (OR 0.6895 CI 0.120.91 P0.001) were the protective factors of esophageal and gastric variceal bleeding (OR 1.499.95 CI 1.333.14P0.020), and prothrombin time (OR 1.2395CI 1.01C 1.01C 3.17P0.032) were all the risk factors. The internal diameter of portal vein (OR 3.6895 CI 2.158.53 / P0.001), splenic vein diameter (OR 1.4595 CI 1.044.98), left gastric vein diameter (OR 1.8895CI 1.044.78P0. 006) and thickness of spleen (OR 2.3295CI 1.015.68p 0.001) were independent risk factors of esophageal variceal bleeding. Conclusion Platelet count and albumin are the protective factors of esophageal and gastric variceal hemorrhage. Child-Pugh score, prothrombin time, portal vein diameter and splenic vein diameter in ultrasound. The diameter of the left gastric vein and the thickness of the spleen were the risk factors for the bleeding of esophageal and gastric varices. Attention should be paid to the changes of the above indexes in clinical work to reduce the risk of bleeding.
【作者单位】：广州市白云区人民医院超声科;广州市白云区人民医院胃肠镜科;广州市番禺区何贤纪念医院超声科;广州市白云区中医医院超声科;广州市白云区人民医院检验科;广州市白云区人民医院内科;
【基金】：广州市白云区科技项目(编号:2016-KZ-015)
【分类号】：R445.1;R575.2

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