食管静脉曲张内镜治疗后早期再出血的相关危险因素的回顾性分析

发布时间：2018-05-17 23:29

本文选题：食管静脉曲张 + 内镜治疗　；参考：《山东大学》2014年硕士论文

【摘要】：目的：通过对比食管静脉曲张患者临床特征和内镜治疗后早期再出血的发生,寻找和证实影响内镜治疗后早期再出血的主要危险因素,并探讨这些危险因素的临床应用意义以及对早期再出血预测诊断价值。方法：收集2011.08.01-2013.10.31期间,在山东大学附属省立医院消化内科住院并行食管静脉曲张内镜治疗的患者。常规记录患者的一般信息、肝功能评估、内镜治疗方案、食管曲张静脉相关特征以及血清学和影像学相关结果(包括：Child-pugh分级、转氨酶、血细胞、尿素氮、胆红素、凝血功能、静脉曲张程度、门静脉内径等)。对上述58例患者内镜治疗后早期再出血的相关情况进行随访,记录是否早期再出血及出血的时间等相关事项。采用卡方检验分析患者相关临床特征与早期再出血的关系；Kaplan-Meier单因素生存分析寻找对早期再出血有影响的临床特征,并建立Cox风险回归模型,进一步确定影响早期再出血的独立危险因素；同时,使用受试者工作曲线(ROC)分析评估这些独立危险因素的临床预测价值。结果： 1、共入组患者58例,其中男性42例,女性16例,平均年龄54.3±12.1岁,其中行EVL治疗的患者共21例(36%),EIS治疗的共30例(52%),EVL+EIS联合治疗的共7例(12%)。术后随访期间,共有11例患者出现早期再出血,其中EVL治疗组6例,EIS治疗组3例,EVL+EIS联合治疗组1例,出血导致死亡2例。 2、且两组在肝功能Child-pugh分级(P=0.008)、门静脉栓子形成(P=0.005)、静脉曲张程度(P=0.043)、术前腹水程度(P=0.005)4方面有显著性差异(p0.05)。在白细胞(WBC)血红蛋白(HB)、血小板(PLT)、门冬氨酸基转移酶(AST)丙氨酸基转移酶(ALT)、白蛋白(ALB)、总胆红素(TBIL)、凝血酶原时间(PT)、纤维蛋白原(Fig)、尿素氮(BUN)不是早期再出血的危险因素。(p0.05) 3、在所研究的患者相关临床特征中,术前静脉曲张程度(P=0.034)、术前腹水程度、(P=0.007)、术前肝功能Child-pugh分级(P0.0001)、血清尿素氮水平(P=0.017)、血清白蛋白水平(P=0.026)、术前曲张静脉红色征(P=0.001)均能显著影响患者的累计无早期出血率。在所建立的Cox风险回归模型中,血清尿素氮水平(危险系数[HR]=1.346,P=0.015)和术前腹水程度(HR=3.185,P=0.029)这两个因素成为内镜治疗后早期再出血的独立危险因素。 4、ROC曲线评估这些独立危险因素对早期再出血的临床预测价值,血清尿素氮水平和术前腹水程度的曲线下面积(AUC)分别为0.683(P=0.071)和0.801(P=0.003),其中术前腹水程度的诊断效率优于其他临床特征。结论： 1、术前Child-pugh分级、术前曲张静脉程度、术前腹水程度、血清尿素氮水平、血清白蛋白水平、术前曲张静脉红色征均是影响曲张静脉内镜治疗后早期再出血的因素：其中尿素氮水平和术前腹水情况是独立危险因素。 2、术前患者腹水情况能够有效判断静脉曲张内镜治疗后患者早期再出血的预
[Abstract]:Objective: By comparing the clinical features of patients with esophageal varices and the occurrence of early rebleeding after endoscopic therapy, the main risk factors affecting early rebleeding after endoscopic therapy were found and confirmed. To explore the clinical application significance of these risk factors and its diagnostic value in early re-bleeding. Methods: Patients with esophageal varices treated by endoscopy in the Department of Digestive Medicine, affiliated Hospital of Shandong University, were collected during the period of October 31, 2011.08.01-2013.10.31. Routine recording of patients' general information, liver function assessment, endoscopic therapy, esophageal varices associated features, and serological and image-related results (including: Child-pugh classification, transaminase, blood cells, urea nitrogen, bilirubin, coagulation function, Degree of varicose vein, diameter of portal vein, etc. 58 patients were followed up to record whether early rebleeding and the time of bleeding. Using chi-square test to analyze the relationship between clinical characteristics and early rebleeding. Kaplan-Meier single factor survival analysis was used to search for the clinical characteristics that had an effect on early rebleeding, and Cox risk regression model was established. The clinical predictive value of these independent risk factors was evaluated by means of ROC-based analysis. Results: 1. There were 58 patients in the group, including 42 males and 16 females with an average age of 54.3 卤12.1 years. Among them, 21 cases were treated with EVL, 30 cases were treated with EIS, and 7 cases were treated with EVL EIS. During the follow-up period, there were 11 cases of early rebleeding, including 6 cases of EVL treatment group, 3 cases of EVL EIS combined treatment group (1 case), and 2 cases of death caused by hemorrhage. 2. There were significant differences between the two groups in Child-pugh grade of liver function (P < 0.008), portal vein embolus formation (P < 0.005), varicose degree (P < 0.043) and ascites (P < 0.05) before operation. Alanine transaminase (alt), Albumin (ALBN), total bilirubin (TBILL), prothrombin time (PTT), fibrinogen (Fign), urea nitrogen (bun) are not risk factors for early rebleeding. 3. Among the clinical characteristics of the patients studied, Preoperative varicose degree, preoperative ascites degree, preoperative Child-pugh grade, serum urea nitrogen level, serum albumin level, preoperative varicose vein red sign and preoperative varicose vein red sign P0. 001 can significantly affect the accumulative rate of no early bleeding. In the established Cox risk regression model, serum urea nitrogen level (risk coefficient [HR] 1.344 P0. 015) and preoperative ascites level (HR3. 185 P0. 029) were independent risk factors for early rebleeding after endoscopic therapy. The ROC curve was used to evaluate the clinical predictive value of these independent risk factors for early rebleeding. The area under the curve of serum urea nitrogen level and preoperative ascites degree were 0.683 and 0.801mP0. 003, respectively. The diagnostic efficiency of preoperative ascites was better than that of other clinical features. Conclusion: 1. Preoperative Child-pugh grade, preoperative varicose vein degree, preoperative ascites degree, serum urea nitrogen level, serum albumin level, The red sign of varicose vein before operation is the factor that affects the early rebleeding after variceal endoscopy. The level of urea nitrogen and ascites before operation are independent risk factors. 2. Preoperative ascites can be used to evaluate the early rebleeding of patients with varicose varices after endoscopic therapy.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R571

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