肝硬化食管胃静脉曲张破裂出血的相关危险因素分析

目的探讨可以评估肝硬化患者食管胃静脉曲张破裂出血风险的临床指标。方法回顾性分析572例合并食管胃静脉曲张破裂出血的肝硬化患者(观察组)及704例未发生出血的肝硬化患者(对照组)的临床资料,对两组间存在差异性的指标运用单因素和多因素Logistic回归模型进行分析。结果两组在肝功能分级状况(P0.05)、血清白蛋白(t=5.05,P=0.000)、凝血酶原时间(t=-2.80,P=0.005)、门静脉内径(t=-2.28,P=0.006)、脾脏厚度(t=-2.73,P=0.006)方面比较,差异有统计学意义。单因素非条件Logistic回归分析显示白蛋白(OR=0.944,P=0.000)、凝血酶原时间(OR=1.067,P=0.007)、门静脉内径(OR=3.423,P=0.007)、脾脏厚度(OR=1.276,P=0.007)与出血存在相关性,进一步多因素非条件Logistic回归分析提示白蛋白(OR=0.936,P=0.000)、门静脉内径(OR=4.098,P=0.013)、脾脏厚度(OR=1.275,P=0.007)是出血的独立危险因素。结论白蛋白、门静脉内径、脾脏厚度是肝硬化并发食管胃静脉曲张破裂出血的独立危险因素,对预测食管胃静脉曲张破裂出血的发生有重要的临床价值,改善白蛋白可在一定程度上减少肝硬化并发食管胃静脉曲张破裂出血的风险。

Risk factors of esophageal and gastric variceal bleeding in patients with cirrhosis

Objective To analyze the risk factors of esophageal and gastric variceal bleeding （EGVB） in patients with cirrhosis. Methods A retrospective study was conducted in 1 276 hospitalized patients with cirrhosis from May. 2005 to Jun. 2012, who were divided into study group as having EGVB （n = 572） and control group as not having EGVB （n = 704）. Differences between two groups were analyzed with univariate analysis and multivariate Logistic regression. Results Child-Pugh classification, serum albumin, prothrombin time, portal vein diameter and spleen thickness were significantly different between two groups （P 〈 0.05）. Univariate analysis showed that serum albumin （ OR = 0.944, P = 0. 000） , prothrombin time （ OR = 1.067, P = 0.007 ）, portal vein diameter （ OR = 3.423, P = 0.007 ） and spleen thickness （ OR = 1.276, P = 0.007） were correlated with EGVB. Multivariate Logistic regression analysis showed that serum albumin （OR =0.936, P =0.000） , portal vein diameter （OR =4.098, P =0. 013） and spleen thickness （ OR = 1.275, P = 0.007） were independent risk factors of EGVB in patients with cirrhosis. Conclusion Low serum albumin level, increased portal vein diameter and spleen thickness are the risk factors of EGVB in patients with cirrhosis, which can be important predictors. To some extent, increasing serum albumin might reduce the risk of EGVB.