胃癌并发出血的危险因素分析

目的分析胃癌合并出血病人的危险因素。方法回顾收集2000~2012年期间就诊于河北医科大学第四医院的胃癌病人。根据病人发病过程中是否并发出血,将病人分为出血组和非出血组。比较两组的临床基线资料、入院时辅助检查资料、手术相关资料和住院期间的主要情况。使用Logistic回归分析胃癌合并出血的危险因素。结果累计入选病人7 919例,其中合并出血病例316例,未并发出血的胃癌病人7 603例。出血组病人男性比例高于非出血组(69.3%比60.3%,P=0.001)。与非出血组相比,出血组病人高血压、糖尿病比例高(均P0.001)。出血组病人吸烟比例较非出血组低(32.0%比39.8%,P=0.005)。与非出血组相比,出血组病人并发梗阻的比例较高(P=0.002),两组病人合并消化道穿孔的比例相似。出血组病人入院时便潜血比例较高(P0.001),血红蛋白、总蛋白和白蛋白水平低于对照组(均P0.001),两组病人天冬氨酸转氨酶和丙氨酸转氨酶水平相似(均P0.05)。两组病人在肿瘤浸润深度和肿瘤TNM分期方面存在明显差异(均P0.05),两组病人M分期情况和术后并发症无明显差异。Logistic回归分析发现,男性、高血压、糖尿病、合并消化道穿孔、肿瘤浸润深度、肿瘤TNM分期、术前白蛋白和总蛋白水平以及入院时便潜血阳性是胃癌合并出血的危险因素(均P0.05)。结论胃癌合并出血的危险因素包括:男性、高血压、糖尿病、合并消化道穿孔、肿瘤TNM分期、术前白蛋白和总蛋白水平以及入院时便潜血阳性。

Risk factors of gastrointestinal bleedingin gastric cancer

Objective To analyze the risk factors of gastrointestinal bleeding in gastric cancer.Methods The patients with gastric cancer admitted to the Fourth Hospital of HebeiMedical University were retrospectively enrolled in this study.All the cases were divided into bleeding group and nonbleeding group according to the incidence of gastrointestinal bleeding.The baseline clinical characteristics,laboratory tests,characteristics of surgery and adverse events during hospitalization were recorded and compared between the two groups.Logistic analysis was used to investigate the risk factors of gastrointestinal bleeding in gastric cancer.Results A total of 7919 cases were enrolled,including 316 cases in the bleeding group and 7600 cases in the non-bleeding group.More male patients were in the bleeding group (69.3％ vs.60.3％,P =0.001).There were more patients with hypertention,diabetes in patients in the bleeding group (all P＜0.001).There were less smokers in the bleeding group than in the non-bleeding group (32.0％ vs.39.8％,P =0.005).The incidence of obstruction wassignificantly higher in the bleeding group than that in the non-bleeding group (P =0.002),but that of perforation was similar between the two groups.The incidence of positive fecal occult blood was higher (P＜0.001),and the levels of hemoglobin,albumin and total protein were lower in the bleeding group (all P＜0.001).No significant difference was found in the levels of ALT and AST between two groups (both P＞0.05).There were no significant differences in infiltration depth and TNM staging of tumor between two groups (both P＜0.05).The results of logistic analysis revealed that male,hypertention,diabetes,perforation,infiltration depth,TNM staging,levels of albumin and total protein as well as positive fecal occult blood were risk factors for gastrointestinal bleeding in gastric cancer (all P＜0.05).Conclusions The risk factors of gastrointestinal bleeding in gastric cancer included male,hypertention,diabetes,perforation,infiltration depth,TNM staging,levels of albumin and total protein as well as positive fecal occult blood.