食管静脉曲张首次硬化剂治疗后早期再出血的危险因素

目的探讨首次食管静脉曲张硬化剂治疗(EVS)对肝硬化患者肝功能、血生化的影响,分析术后早期再出血的危险因素。方法回顾性分析2016年1月-2017年12月于首都医科大学附属北京佑安医院住院,经首次EVS治疗的120例肝硬化伴食管静脉曲张破裂出血患者的临床资料,按照不同肝功能Child-Pugh分级,对比EVS治疗前后的肝功能、血生化检测结果,评价EVS对上述指标的影响;并将术后14 d内出血的患者定义为早期再出血,分为出血组与未出血组,应用logistic回归分析,分析影响再出血的主要危险因素。正态分布的计量资料2组间比较采用t检验,非正态分布的计量资料2组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ2检验或Fisher确切概率法。结果 Child-Pugh A级、B级患者EVS治疗前后,TBil(Z=-3. 975,P <0. 001; Z=-3. 670,P <0. 001)、DBil(Z=-3. 455,P=0. 001; Z=-3. 086,P=0. 002)、WBC(Z=-2. 811,P=0. 005; Z=-3. 683,P <0. 001)的变化差异均有统计学意义。EVS术后早期再出血率为10%(12/120),logistic回归分析提示腹水量(比值比=2. 92,P=0. 047)及伴有门静脉血栓(比值比=4. 94,P=0. 018)均是导致EVS术后早期再出血的独立危险因素。结论 EVS治疗对肝功能影响不大,应警惕治疗过程中细菌感染的可能。术前应及时减少腹水量,从而降低EVS后早期再出血的发生率。对于伴有门静脉血栓的患者,应结合患者病情,评估治疗风险,选择更适当的治疗方案。

Risk factors for early rebleeding after initial sclerotherapy for esophageal varices

Objective To investigate the effect of initial esophageal variceal sclerotherapy( EVS) on liver function and blood biochemistry in patients with liver cirrhosis and the risk factors for early rebleeding after initial EVS. Methods A retrospective analysis was performed for the clinical data of 120 cirrhotic patients with esophageal variceal bleeding who were hospitalized in Beijing YouAn Hospital,Capital Medical University,from January 2016 to December 2017 and received initial EVS. The patients were divided into groups according to the Child-Pugh class,and liver function and blood biochemistry were compared between groups before and after treatment to evaluate the effect of EVS on the above indices. Early rebleeding after surgery was defined as bleeding within 14 days after surgery. The patients were divided into bleeding group and non-bleeding group according to the presence or absence of early rebleeding,and a logistic regression analysis was performed to investigate the main risk factors for early rebleeding. The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test or the Fisher’ s exact test was used for comparison of categorical data between groups. Results After treatment,Child-Pugh class A/B patients had significant changes in total bilirubin( Z =-3. 975 and-3. 670,both P < 0. 001),direct bilirubin( Z =-3. 455 and-3. 086,P = 0. 001 and 0. 002),and white blood cell count( Z =-2. 811 and-3. 683,P = 0. 005 and P <0. 001). Early rebleeding rate after EVS was 10%( 12/120). The logistic regression analysis showed that the amount of ascites( odds ratioOR]= 2. 92,P = 0. 047) and presence of portal vein thrombosis( OR = 4. 94,P = 0. 018) were independent risk factors for early rebleeding after EVS. Conclusion EVS does not have a significant impact on liver function,and bacterial infection should be taken seriously during treatment. The amount of ascites should be reduced before surgery,in order to reduce the incidence rate of early rebleeding after EVS.For patients with portal vein thrombosis,the risk of treatment should be evaluated and an appropriate treatment regimen should be selected based on patient’s conditions.