HBV相关肝硬化合并急性上消化道出血的危险因素分析

于芝瑞; 魏国喜; 刘其昌; 靳培敏

doi:10.3969/j.issn.1001-5256.2017.05.013

HBV相关肝硬化合并急性上消化道出血的危险因素分析

DOI: 10.3969/j.issn.1001-5256.2017.05.013

巩义市人民医院急诊科

详细信息

中图分类号: R575.2;R512.62;R573.2
计量
- 文章访问数: 1660
- HTML全文浏览量: 42
- PDF下载量: 449
- 被引次数: 0
出版历程
- 出版日期: 2017-05-20

Risk factors for HBV-related liver cirrhosis complicated by acute upper gastrointestinal bleeding

Emergency Department, Gongyi City People’s Hospital

摘要

摘要:
目的分析HBV相关肝硬化合并急性上消化道出血（AUGIB）的危险因素。方法以2011年1月-2011年12月于巩义市人民医院住院的58例HBV相关肝硬化合并AUGIB患者为研究组,另外随机抽取同期未发生上消化道出血的100例HBV相关肝硬化患者为对照组。收集其入院时的一般临床资料。计量资料组间比较采用t检验;计数资料组间比较采用χ2检验。采用多因素Cox回归模型分析其影响AUGIB的危险因素;采用life tables法统计患者1、2、3年累积生存率并绘制生存曲线。结果 HBV相关肝硬化并发AUGIB患者的1、2、3年的累积生存率分别为72.2%、51.9%、35.2%,中位生存时间是24.7个月。单因素分析结果显示:出血史（χ2=7.128,P=0.008）、病程（t=8.283,P<0.001）、不良饮食习惯（χ2=7.612,P=0.006）、Child-Pugh分级（χ2=6.045,P=0.049）、食管静脉曲张程度（χ2=46.241,P<0.001）、...
- 肝硬化 /
- 急性上消化道出血 /
- 危险因素
Abstract:
Objective To investigate the risk factors for HBV-related liver cirrhosis complicated by acute upper gastrointestinal bleeding (AUGIB) .Methods A total of 58 patients with HBV-related liver cirrhosis complicated by AUGIB who were hospitalized in our hospital from January to December, 2011 were enrolled as study group, and 100 patients with HBV-related liver cirrhosis who did not experience upper gastrointestinal bleeding during the same period of time were enrolled as control group.Their general clinical data were collected.The t-test was used for comparison of continuous data between groups, the chi-square test was used for comparison of categorical data between groups, the multivariate Cox regression model was used to analyze the risk factors, and the life table method was used to analyze 1-, 2-, and 3-year cumulative survival rates and plot survival curves.Results The 1-, 2-, and 3-year cumulative survival rates in the patients with HBV-related liver cirrhosis complicated by AUGIB were 72.2%, 51.9%, and 35.2%, respectively, with a median survival time of 24.7 months.The univariate analysis showed that AUGIB was associated with bleeding history (χ2=7.128, P=0.008) , course of disease (t=8.283, P<0.001) , bad eating habits (χ2=7.612, P=0.006) , Child-Pugh class (χ2=6.045, P=0.049) , degree of esophageal varices (χ2=46.241, P<0.001) , gastric varices (χ2=14.211, P<0.001) , and portal hypertension (χ2=6.846, P=0.009) .The multivariate Cox regression analysis revealed that course of disease (RR=0.745, 95% CI:0.824-0.967, P=0.026) , bad eating habits (RR=1.426, 95% CI:1.033-2.582, P=0.032) , Child-Pugh class (RR=2.032, 95% CI:1.05-2.34, P=0.036) , degree of esophageal varices (RR=0.796, 95% CI:1.23-3.37, P=0.015) , degree of gastric varices (RR=0.825, 95% CI:2.46-3.92, P=0.043) , and portal hypertension (RR=0.983, 95% CI:1.26-3.75, P=0.007) were independent risk factors for the prognosis of patients with HBV-related liver cirrhosis complicated by AUGIB.Conclusion Course of disease, bad eating habits, Child-Pugh class, degree of esophageal varices, degree of gastric varices, and portal hypertension are independent risk factors for the prognosis of patients with HBV-related liver cirrhosis complicated by AUGIB.These factors should be taken seriously by clinical physicians to improve patients' prognosis.
- liver cirrhosis /
- acute upper gastrointestinal bleeding /
- risk factors

HTML全文

参考文献(14)

[1]Experts in combined team of the Major Special Project of Ministry of Science and Technology supported by China’s“Twelfth FiveYear Plan”.Management of clinical diagnosis, evaluation, and antiviral therapy for HBV-related cirrhosis[J].J Clin Hepatol, 2014, 30 (2) :99-108. (in Chinese) 科技部十二五重大专项联合课题组专家.乙型肝炎病毒相关肝硬化的临床诊断、评估和抗病毒治疗的综合管理[J].临床肝胆病杂志, 2014, 30 (2) :99-108.

[2]LI Y, SUN CY, ZHOU Y.Non-invasive diagnosis of esophageal varices in patients with cirrhosis induced by viral hepatitis[J].Chin J Clin Infect Dis, 2013, 6 (3) :144-147. (in Chinese) 李焱, 孙长宇, 周言.非侵入性检查对病毒性肝炎肝硬化食管静脉曲张的评估[J].中华临床感染病杂志, 2013, 6 (3) :144-147.

[3]Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:a 2015 update[J].J Clin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960.

[4]GUO HJ, TONG XF.Observation of Zeqi decoction on hemodynamics and liver fibrosis indexes in liver cirrhosis patients with portal hypertension[J].Hebei J TCM, 2015, 37 (1) :18-21. (in Chinese) 郭海军, 佟雪飞.泽芪汤对肝硬化门静脉高压症患者血流动力学及肝纤维化指标的影响[J].河北中医, 2015, 37 (1) :18-21.

[5]CERINI F, GONZALEZ JM, TORRES F, et al.Impact of anticoagulation on upper-gastrointestinal bleeding in cirrhosis.A retrospective multicenter study[J].Hepatology, 2015, 62 (2) :575-583.

[6]XU X, WANG BM, DENG BR, et al.Analysis of emergency gastroscopy diagnosis in cirrhosis patients with upper gastrointestinal hemorrhage[J].Chin J Dig Endose, 2011, 28 (4) :220-222. (in Chinese) 徐昕, 王邦茂, 邓宝茹, 等.肝硬化并上消化道出血急诊胃镜诊治分析[J].中华消化内镜杂志, 2011, 28 (4) :220-222.

[7]LIU GY.Clinical features of cirrhosis with non-variceal upper gastrointestinal hemorrhage[J].China Pract J Med, 2016, 43 (2) :62-63. (in Chinese) 刘广裕.肝硬化合并非静脉曲张性上消化道出血的临床特征[J].中国实用医刊, 2016, 43 (2) :62-63.

[8]CHEN Y, TIAN H, HUANG XL, et al.Clinical analysisi of nonvariceal upper gastrointestinal bleeding in cirrhotic patients[J].JSun Yat-sen Univ:Med Sci, 2014, 35 (2) :278-283. (in Chinese) 陈妤, 田虹, 黄晓丽, 等.肝硬化合并非静脉曲张性上消化道出血临床分析[J].中山大学学报:医学科学版, 2014, 35 (2) :278-283.

[9]ZHANG L, WANG Y, LI HL, et al.Analysis on correlative factors causing nosocomial infections among patients with hepatitis B liver cirrhosis and gastrointestinal haemorrhage[J].Chin J Nosocomiol, 2016, 26 (17) :3903-3905. (in Chinese) 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.

[10]LI XL, CHEN MS, GAN QR, et al.Risk factors for antibiotic prophylaxis failure in patients with liver cirrhosis and upper gastrointestinal bleeding[J].J Clin Hepatol, 2016, 32 (2) :288-291. (in Chinese) 李孝楼, 陈明胜, 甘巧蓉, 等.肝硬化上消化道出血预防性抗感染治疗失败的影响因素[J].临床肝胆病杂志, 2016, 32 (2) :288-291.

[11]WANG LR.Analysis of 46 cases of elderly hepatocirrhosis patients combined with upper gastrointestinal bleeding[J].Chin J Gerontol, 2012, 32 (24) :5608-5609. (in Chinese) 王连荣.老年肝硬化合并上消化道出血46例[J].中国老年学杂志, 2012, 32 (24) :5608-5609.

[12]LIU JJ.Clinical analysis of Somatostatin combined omeprazole in treatment of stomach bleeding caused by liver cirrhosis portal hypertension[J].Nei Mongol J TCM, 2013, 32 (28) :30-31. (in Chinese) 刘建军.生长抑素联合奥美拉唑治疗肝硬化门脉高压性胃出血临床分析[J].内蒙古中医药, 2013, 32 (28) :30-31.

[13]ZHI HF.Clinical analysis of somatostatin combined omeprazole in treatment of stomach bleeding caused by liver cirrhosis portal hypertension[J].J North Phar, 2013, 10 (5) :41. (in Chinese) 智恒峰.生长抑素联合奥美拉唑治疗肝硬化门脉高压性胃出血临床观察[J].北方药学, 2013, 10 (5) :41.

[14]GAO CG, XIE F, FENG YD.Effect of somatostatin combined with pantoprezole in treatment of liver cirrhosis with upper gastrointestinal haemorrhage[J].J Clin Hepatol, 2016, 32 (2) :284-287. (in Chinese) 高成广, 谢峰, 冯亚东.生长抑素联合泮托拉唑治疗肝硬化合并上消化道出血的效果观察[J].临床肝胆病杂志, 2016, 32 (2) :284-287.

施引文献

资源附件(0)

访问统计