肝硬化食管胃静脉曲张早期再出血的危险因素分析

发布时间：2018-06-15 12:54

本文选题：肝硬化 + 出血　；参考：《延安大学》2017年硕士论文

【摘要】：目的:探讨肝硬化食管胃静脉曲张(esophageal gastric varices,EGV)早期再出血的危险因素,降低肝硬化食管胃静脉曲张出血(esophageal gastric varices bleeding,EGVB)患者早期再出血的发生,改善患者预后,为临床工作取得数据支持,获得社会及经济效益。方法:收集2014年1月-2016年1月期间于陕西省人民医院确诊并经过治疗的肝硬化合并EGVB患者(325例)的临床资料,按照其6周内是否发生早期再出血,分为病例组及对照组,对两组患者的临床资料、实验室及影像学检查指标进行比较,分析得出肝硬化EGV患者早期再出血的相关危险因素。结果:325例患者中,66例(20.31%)发生再出血的患者作为病例组,259例(79.69%)未再出血的患者作为对照组。经单因素分析得病例组与对照组之间糖尿病病史(P=0.001),血小板(platelets,PLT)(P=0.001),总胆红素(total bilirubin,TBiL)(P=0.001),凝血酶原时间(prothrombin time,PT)(P=0.001),国际标准化比值(international normalized ratio,INR)(P=0.002),门静脉内径(P=0.001),脾静脉内径(P=0.039),脾脏长度(P=0.004),脾脏厚度(P=0.005),脾脏大小(P=0.009),血小板与脾长径比值(P=0.001),血小板与脾大小比值(P=0.001),门静脉血栓(portal vein thrombosis,PVT)(P=0.001),食管静脉曲张程度(P=0.01),红色征(P=0.008),肝功能Child-Pugh分级(P=0.004)。Logistic回归分析得1.病例组门静脉内径、脾静脉内径、脾脏长度、血小板与脾长径比值、TBiL、PT、INR平均值较对照组明显升高(P0.05)。2.病例组PLT平均值较对照组低(P=0.001)。3.两组间有无PVT、有无红色征、肝功能Child-Pugh分级、食管静脉曲张程度比较差异有统计学意义(P0.05)。4.食管静脉曲张的程度与肝功能Child-Pugh分级呈正相关关系,相关系数rs=0.416,P0.05。5.对于病毒性肝硬化出血且既往无抗病毒药物使用史的患者,进行抗病毒治疗与否与早期再出血发生率之间无相关关系(P=0.546)。6.病例组普萘洛尔的使用率明显低于对照组(P=0.024)。7.治疗方式的选择对肝硬化早期再出血可能无显著影响。结论:1.门静脉内径、脾静脉内径、脾脏长度、PLT计数、血小板与脾长径比值、凝血指标(PT、INR)及TBiL可能是肝硬化EGV患者早期再出血的危险因素。2.合并PVT的肝硬化EGV患者早期再出血的风险较大。3.肝功能Child-Pugh分级、食管静脉曲张程度是肝硬化EGVB患者早期再出血的危险因素之一,肝功能Child-Pugh分级为C级,食管静脉呈重度曲张,红色征为阳性的肝硬化EVGB患者早期再出血的风险越大。4.肝功能Child-Pugh分级与食管静脉曲张的程度呈相关关系,且呈正相关关系。5.对于病毒性肝硬化出血且既往无抗病毒药物使用史的患者,进行抗病毒治疗与否与早期再出血发生率之间可能无相关关系。6.对肝硬化EGVB患者应用普萘洛尔可显著降低其早期再出血风险。7.在二级预防中,硬化剂注射治疗(endoscopic injection sclerotherapy,EIS)与套扎治疗(endoscopic variceal ligation,EVL)对肝硬化EGVB患者早期再出血发生率的影响无显著差异。
[Abstract]:Objective: to explore the risk factors of early rebleeding in patients with esophageal and gastric varices due to cirrhosis, to reduce the occurrence of early rebleeding in patients with esophageal and gastric varices bleeding due to cirrhosis, to improve the prognosis of patients, and to obtain data support for clinical work. To obtain social and economic benefits. Methods: the clinical data of 325 cases of cirrhosis with EGVB diagnosed and treated in Shaanxi Provincial people's Hospital from January 2014 to January 2016 were collected. According to whether early rebleeding occurred within 6 weeks, the patients were divided into two groups: the case group and the control group. The clinical data, laboratory and imaging findings of the two groups were compared, and the risk factors of early rebleeding in patients with EGV were analyzed. Results among 325 cases, 66 cases (20. 31%) with rebleeding were taken as the case group (259 cases) and 79.69 cases) the patients without rebleeding were taken as the control group. The history of diabetes between the case group and the control group was analyzed by univariate analysis. The results showed that the history of diabetes between the case group and the control group was as follows: P0. 001, PLT, P0. 001, total bilirubinus, TBiLB, P0. 001, prothrombin time, P0. 001, international standard ratio, international normalized, P0. 002, P0. 001, P0. 001, P0. 039, P0. 004, P0. 004, P0. 004, P0. 004, P0. 004, P0. 001, P0. 001, P0. 001, P0. 001, P0. 039, P0. 004, P0. 004, P0. 004. The ratio of platelets to spleen length to spleen was 0.001, the ratio of platelet to spleen was 0.001, the portal vein thrombotic portal vein thromboplasmosis was PVT 0.001, the degree of esophageal varices was 0. 01, the red sign was P0. 008, and the Child-Pugh grade of liver function was 0. 004n. logistic regression analysis showed that: P0. 001, P0. 01, P0. 008, and Child-Pugh grade, P0. 004n. Logistic regression analysis of portal vein thromboembolism portal, P0. 01, P0. 001, P0. 008, and Child-Pugh grade of liver function were obtained by logistic regression analysis. Compared with the control group, the mean value of the internal diameter of portal vein, the length of spleen and the ratio of platelet to splenic length were significantly increased in the case group compared with the control group. The average value of PLT in the case group was lower than that in the control group. There were significant differences in PVT, red sign, Child-Pugh grade of liver function and degree of esophageal varices between the two groups. The degree of esophageal varices was positively correlated with Child-Pugh grade of liver function, and the correlation coefficient was 0.416% (P 0.05.5). For patients with viral cirrhosis bleeding and no history of antiviral drug use, there was no correlation between antiviral therapy and the incidence of early rebleeding. The usage rate of propranolol in the case group was significantly lower than that in the control group. The choice of treatment may have no significant effect on early rebleeding of liver cirrhosis. Conclusion 1. Portal vein diameter, splenic length and PLT count, platelet to spleen length ratio, coagulation index PTT INR) and TBiL may be the risk factors of early rebleeding in patients with EGV. Cirrhotic EGV patients with PVT have a higher risk of early rebleeding. Child-Pugh grade of liver function and degree of esophageal varices were one of the risk factors for early rebleeding in patients with liver cirrhosis and EGVB. Child-Pugh grade of liver function was grade C, esophageal vein presented severe varices. The higher the risk of early rebleeding in patients with EVGB with positive red signs. 4. Child-Pugh grade of liver function was correlated with the degree of esophageal varices, and there was a positive correlation between Child-Pugh grade and esophageal varicose degree. For patients with viral cirrhosis bleeding and no previous history of antiviral drug use, there may be no correlation between antiviral therapy and the incidence of early rebleeding. Propranolol significantly reduced the risk of early rebleeding in patients with cirrhosis of EGVB. In secondary prevention, there was no significant difference between the effect of sclerosing agent injection on the incidence of early rebleeding in patients with liver cirrhosis and the effect of ligation on the incidence of early rebleeding in patients with liver cirrhosis.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2

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