【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χ~2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(χ~2=7.128,P=0.008)、病程(t=8.283,P<0.001)、不良饮食习惯(χ~2=7.612,P=0.006)、Child-Pugh分级(χ~2=6.045,P=0.049)、食管静脉曲张程度(χ~2=46.241,P<0.001)、胃底静脉曲张(χ~2=14.211,P<0.001)及门静脉高压(χ~2=6.846,P=0.009)在2组间比较,差异均有统计学意义。多因素Cox回归分析显示,病程[(风险比)RR=0.745,95%CI(95%可信区间):0.824~0.967,P=0.026]、不良饮食习惯(RR=1.426,95%CI:1.033~2.582,P=0.032)、Child-Pugh分级(RR=2.032,95%CI:1.05~2.34,P=0.036)、食管静脉曲张程度(RR=0.796,95%CI:1.23~3.37,P=0.015)、胃底静脉曲张(RR=0.825,95%CI:2.46~3.92,P=0.043)、门静脉高压(RR=0.983,95%CI:1.26~3.75,P=0.007)为AUGIB发生的独立危险因素。结论病程、不良饮食习惯、Child-Pugh分级、食管静脉曲张程度、胃底静脉曲张以及门静脉高压是影响HBV相关肝硬化并发AUGIB的独立危险因素,临床医生应加以重视,以期改善患者的预后。更多还原

【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(χ~2=7.128,P=0.008),course of disease(t=8.283,P<0.001),bad eating habits(χ~2=7.612,P=0.006),Child-Pugh class(χ~2=6.045,P=0.049),degree of esophageal varices(χ~2=46.241,P<0.001),gastric varices(χ~2=14.211,P<0.001),and portal hypertension(χ~2=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.更多还原