肝硬化患者上消化道出血与血脂水平相关性分析

目的分析肝硬化患者上消化道出血与血脂水平的相关性。方法选取2017年7月至2019年6月126例肝硬化合并上消化道出血患者作为病例组,选取同期100例未发生上消化道出血的肝硬化患者作为对照组。收集患者一般资料,并测定三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、载脂蛋白E(ApoE)。进行单因素分析、Spearman秩相关分析、Logistics回归分析,并作ROC曲线。结果病例组患者的TG、TC、HDL-C、LDL-C、ApoA1、ApoB、ApoE水平均低于对照组(P<0.05)。Spearman秩相关分析显示,TC、HDL-C、LDL-C、ApoA1、ApoB水平与上消化道出血呈负相关(P<0.05),TG、ApoE水平与上消化道出血无显著相关性(P>0.05)。Logistics回归分析显示,TC、LDL-C低水平是上消化道出血的危险因素。LDL-C作为上消化道出血预测因子的准确性高于TC,当LDL-C水平低于2.565 mmol/L时(AUC=0.861,灵敏度82%,特异性73%),及TC水平低于3.995 mmol/L时(AUC=0.736,灵敏度75%,特异性64%),上消化道出血风险明显增加。结论血脂代谢异常与肝硬化患者上消化道出血密切相关,TC、LDL-C低水平是上消化道出血的危险因素,当LDL-C水平低于2.565 mmol/L、TC水平低于3.995 mmol/L时,上消化道出血风险明显增加。

The Correlation Between Upper Gastrointestinal Hemorrhage and Levels of Blood Lipids in Patients with Liver Cirrhosis

Objective To analyze the correlation between upper gastrointestinal hemorrhage and levels of blood lipids in patients with liver cirrhosis.Methods 126 patients with liver cirrhosis and upper gastrointestinal hemorrhage who were admitted from July,2017 to June,2019 were selected as the case group.100 patients with liver cirrhosis but without upper gastrointestinal hemorrhage were selected as the control group.General data of all subjects were collected.Triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),apolipoprotein A1(ApoA1),apolipoprotein B(ApoB)and apolipoprotein E(ApoE)were determined among all subjects.Univariate analysis,Spearman rank correlation analysis and logistics regression analysis were performed.ROC curves were drawn.Results Levels of TG,TC,HDL-C,LDL-C,ApoA1,ApoB and ApoE in the case group were lower than those in the control group(all P<0.05).Spearman rank correlation analysis showed that levels of TC,HDL-C,LDL-C,ApoA1 and ApoB were negatively correlated with upper gastrointestinal hemorrhage(all P<0.05).However,there was no significant correlation between TG and ApoE levels and upper gastrointestinal hemorrhage(all P>0.05).Logistics regression analysis showed that low levels of TC and LDL-C were risk factors for upper gastrointestinal hemorrhage.LDL-C is more accurate than TC as the predictor of upper gastrointestinal hemorrhage.When the LDL-C level was lower than 2.565 mmol/L(AUC=0.861,sensitivity of 82%,specificity of 73%)and the TC level was lower than 3.995 mmol/L(AUC=0.336,sensitivity of 75%,specificity of 64%),the risk of upper gastrointestinal hemorrhage increased significantly.Conclusion Abnormal blood lipid metabolism is closely related to upper gastrointestinal hemorrhage in patients with cirrhosis.Low levels of TC and LDL-C are risk factors for upper gastrointestinal hemorrhage.When the LDL-C level is lower than 2.565 mmol/L and TC level is lower than 3.995 mmol/L,the risk of upper gastrointestinal hemorrhage increases significantly.