肝静脉压力梯度（HVPG）在内镜下食管静脉曲张套扎术（EVL）后早期出血的预测作用

发布时间：2018-06-03 10:18

  本文选题：肝硬化 + 门静脉高压　； 参考：《山东大学》2014年硕士论文

【摘要】：目的： 食管静脉曲张破裂出血是肝硬化门脉高压症的严重并发症,出血量大,病情凶险,病死率高。内镜下食管静脉曲张套扎术(endoscopic variceal ligation,EVL)是预防和治疗食管静脉曲张破裂出血的首选方法,但术后早期再出血的发生率较高,常危及病人生命,但是对EVL术后早期再出血的相关因素的研究分析较少,特别是其与肝静脉压力梯度(HVPG)之间的相关性研究。本研究将继续分析影响EVL术后早期再出血的相关因素,特别是HVPG与EVL术后早期再出血的关系,旨在探讨HVPG对EVL术后早期出血的预测作用。 材料和方法： 回顾性分析山东省立医院东院消化内科自2010年10月至2014年3月期间接受内镜下食管胃底静脉曲张套扎治疗并在套扎治疗前1个月内曾行过HVPG测定的患者共105例。收集他们住院期间的HVPG测定值,肝硬化病因、既往出血史、外科手术史及相关治疗史,凝血功能、血常规、肝功生化等指标,肝性脑病、腹水等并发症的发生情况,以及红色征、是否合并门脉高压性胃病等内镜检查结果和套扎环数、套扎静脉是否渗血等治疗时内镜下所见等相关数据,并对上述105例病人套扎后24小时至2周内是否出血及是否发生严重并发症或死亡等情况进行随访。然后进行下列两项工作： 1、根据套扎后24小时至2周内是否出血,将患者分为出血组及未出血组,计量资料采用两样本比较的秩和检验,计数资料采用卡方检验,寻找影响EVL术后早期再出血的独立影响因素；出血率的多因素分析采用Logistic回归分析,并得出相关因素的危险度。 2、准确性分析应用ROC曲线分析,根据结果中各个可能切点的灵敏度和特异度计算Youden指数最大的点为临界点,并结合临床计算出最佳诊断界限值。以P0.05为差异具有统计学意义。所有统计分析均通过SPSS16统计软件完成,显著性水平α=0.05。 结果： 1、经随访,资料齐全的病例105例,出血组11例(10.48%),未出血组94例(89.52%)。经统计分析,PT、INR、肝功分级、ALT、HVPG为EVL术后早期再出血的独立危险因素,P值分别为0.031、0.030、0.005、0.047、0.006。而两组在性别、年龄、肝硬化病因、是否合并肝癌、是否行过脾切除或脾栓塞术、腹水级别、肝性脑病级别、既往消化道出血史、既往食管静脉曲张套扎史、既往PTVE史、是否服用非选择性β-受体阻断剂(NSBBs)、冬氨酸氨基转移酶(AST)、血清总胆红素(TBIL)、肌配(CR)、尿素氮(BUN)、白细胞计数(WBC)、血小板计数(PLT)、血红蛋白(Hb)、食管静脉曲张程度、红色征、是否合并有胃底静脉曲张、是否有门脉高压性胃病、是否同时行胃底静脉曲张治疗、套扎的点数、套扎后食管曲张静脉是否立即消失、套扎过程中是否出血渗血、术后是否合并腹膜炎等并发症情况没有显著性差异(其P值均0.05)。经logistic回归多因素分析,最终只有HVPG具有统计学意义(P=0.005)。 2、经ROC分析,HVPG的曲线下面积是0.866,最终得出当HVPG≥16mmHg时,出血组及未出血组的术后早期出血有显著性差异(P0.001),且曲线下面积最大为0.838,有较高准确性,其敏感度为90.9%,特异度为76.6%,对预测EVL术后早期出血有统计学意义。 结论： 经统计学分析,只有HVPG是EVL术后早期再出血的独立危险因素。对HVPG关于EVL术后早期再出血行ROC分析,得出曲线下面积(AUC)为0.866,当HVPG≥16mmHg时,AUC为0.838,有一定准确性,其敏感度为90.9%,特异度为76.6%。
[Abstract]:Objective:
Esophageal variceal bleeding is a serious complication of portal hypertension of the liver cirrhosis. The bleeding amount is large, the condition is dangerous and the mortality rate is high. Endoscopic esophageal variceal ligation (endoscopic variceal ligation, EVL) is the first choice to prevent and treat esophageal variceal bleeding, but the incidence of early rebleeding after operation is high, often dangerous. And patient life, but there are few studies on the related factors of early rebleeding after EVL, especially their correlation with the hepatic venous pressure gradient (HVPG). This study will continue to analyze the related factors affecting early rebleeding after EVL, especially the relationship between HVPG and the early rebleeding after EVL, which aims to explore HVPG for EVL. Predictive effect of posterior early bleeding.
Materials and methods:
Retrospective analysis was carried out in the Department of Gastroenterology in the Eastern Hospital of Shangdong Province-owned Hospital from October 2010 to March 2014 to receive endoscopic variceal ligation of the esophageal and gastric fundus varices and 105 patients who had undergone HVPG determination within 1 months before the ligation. The values of HVPG, the etiology of liver harden, the history of previous bleeding, the history of surgery and the history of surgery were collected. Related treatment history, blood coagulation function, blood routine, liver function and other indexes, hepatic encephalopathy, ascites and other complications, red sign, endoscopic examination and ligation of portal hypertension and ligation of blood, and other related data under endoscopic treatment, and 24 small cases after ligation of the 105 patients. The following two tasks were followed up: whether bleeding occurred during the 2 weeks, and whether serious complications or death occurred.
1, according to the bleeding of 24 hours to 2 weeks after the ligation, the patients were divided into bleeding group and non bleeding group. The measurement data were compared with the rank sum test of two samples. Counting data were checked by chi square test to find independent factors affecting early rebleeding after EVL; the multiple factor analysis of bleeding rate was analyzed by Logistic regression analysis, and the correlation was obtained. The risk of factors.
2, the accuracy analysis applied the ROC curve analysis. According to the sensitivity and specificity of the possible tangent points in the results, the maximum Youden index point was calculated as the critical point, and the best diagnostic threshold value was calculated with the clinical calculation. The difference of P0.05 was statistically significant. All the statistical analysis was completed by the SPSS16 statistical software, and the significant level of alpha =0.05. was achieved.
Result锛，

本文编号：1972427