摘要
目的分析肝硬化门静脉高压症患者首次上消化道出血(UGH)疾病转归的影响因素。方法选取2019-06-20-2021-08-20郑州市第三人民医院收治的216例肝硬化门静脉高压症首次UGH患者作为研究对象,根据预后不同分为预后良好组(N=171)和预后不良组(N=45),对比2组患者一般资料和临床相关指标,包括凝血酶原时间(PT)、血管紧张素-Ⅱ和凝血酶时间(TT)等,多因素分析肝硬化门静脉高压症患者上消化道出血疾病转归的影响因素,分析各个影响因素的预测价值。结果2组患者肝功能Child-Pugh分级(χ^(2)=60.904,P<0.001)、食管静脉曲张程度(χ^(2)=17.500,P<0.001)、休克指数(χ^(2)=91.154,P<0.001)、24 h内再出血(χ^(2)=46.095,P<0.001)、非甾体药物用药史(χ^(2)=9.518,P=0.002)、饮酒史(χ^(2)=13.973,P<0.001)、血清PT水平(t=2.408,P=0.017)、血管紧张素-Ⅱ水平(t=10.197,P<0.001)和TT水平(t=5.764,P<0.001)比较,差异有统计学意义;多因素分析结果显示,肝功能Child-Pugh分级C级(OR=6.341,95%CI为2.183~18.417,P<0.001)、食管静脉曲张中重度(OR=3.719,95%CI为1.634~8.463,P=0.011)、有24 h内再出血(OR=3.355,95%CI为1.372~8.204,P=0.024)、休克指数>1.5(OR=4.797,95%CI为1.915~12.014,P<0.001)、有非甾体药物用药史(OR=3.306,95%CI为1.658~6.594,P=0.027)、PT>22 s(OR=3.589,95%CI为1.640~7.853,P=0.015)、血管紧张素-Ⅱ>4.4 pg/mL(OR=3.792,95%CI为1.589~9.047,P=0.007)、TT>22 s(OR=3.531,95%CI为1.657~7.526,P=0.018)和饮酒史(OR=3.610,95%CI为1.642~7.935,P=0.004)是肝硬化门静脉高压症患者首次UGH预后不良的危险因素;采用Logistic回归模型统计分析数据集,根据预测值和真实值绘制ROC曲线,结果表明,AUC为0.913,95%CI为0.834~0.949,预测灵敏度为84.44%,特异度为91.23%。结论肝硬化门静脉高压症患者首次UGH疾病转归受肝功能分级、食管静脉曲张程度、24 h内再出血、休克指数等多种因素影响,根据相关因素临床制定干预措施,对改善患者预后具有积极意义。
Objective To analyze the factors affecting the prognosis of the first upper gastrointestinal hemorrhage(UGH)in patients with cirrhosis and portal hypertension.Methods Totally 216 patients with the first UGH of cirrhotic portal hypertension admitted to Zhengzhou Third People’s Hospital from June 20,2019 to August 20,2021 were divided into good prognosis group(N=171)and poor prognosis group(N=45)according to the different prognosis.The general data and clinical related indicators[prothrombin time(PT),angiotensin-Ⅱ,thrombin time(TT)]of the two groups were compared,Multivariate analysis of the factors affecting the prognosis of upper gastrointestinal bleeding in patients with cirrhosis and portal hypertension,and analysis of the predictive value of each influencing factor.Results There were statistically significant differences in Child-Pugh grading of liver function(χ^(2)=60.904,P<0.001),degree of esophageal varices(χ^(2)=17.500,P<0.001),shock index(χ^(2)=91.154,P<0.001),rebleeding within 24 hours(χ^(2)=46.095,P<0.001),history of non-steroidal drugs(χ^(2)=9.518,P=0.002),drinking history(χ^(2)=13.973,P<0.001),serum PT level(t=2.408,P=0.017),angiotensin-Ⅱlevel(t=10.197,P<0.001)and TT level(t=5.764,P<0.001)between two groups.Multivariate analysis showed that the Child-Pugh grading of liver function was grade C(OR=6.341,95%CI:2.183-18.417,P<0.001),moderate and severe esophageal varices(OR=3.719,95%CI:1.634-8.463,P=0.011),rebleeding within 24hours(OR=3.355,95%CI:1.372-8.204,P=0.024),shock index>1.5(OR=4.797,95%CI:1.915-12.014,P<0.001),had a history of using non-steroidal drugs(OR=3.306,95%CI:1.658-6.594,P=0.027),PT>22s(OR=3.589,95%CI:1.640-7.853,P=0.015),angiotensin-Ⅱ>4.4pg/ml(OR=3.792,95%CI:1.589-9.047,P=0.007),TT>22s(OR=3.531,95%CI:1.657-7.526,P=0.018),and drinking history(OR=3.610,95%CI:1.642-7.935,P=0.004)were risk factors for poor prognosis of the first UGH in patients with cirrhosis and portal hypertension.Logistic regression model was used to analyze the data set,and the ROC curve was drawn according to the predicted value and the true value.The AUC was 0.913(95%CI was 0.834-0.949),the prediction sensitivity was 84.44%,and the specificity was 91.23%.Conclusions The prognosis of the first UGH in patients with cirrhosis and portal hypertension is affected by many factors,such as liver function grade,esophageal varices,rebleeding within 24hours,shock index,etc.The clinical intervention measures based on relevant factors have positive significance in improving the prognosis of patients.
作者
岳雅伦
黄书亮
YUE Ya-lun;HUANG Shu-liang(Department of Gastroenterology,Zhengzhou Third People's Hospital,Zhengzhou 450000,China)
出处
《社区医学杂志》
CAS
2023年第2期88-93,共6页
Journal Of Community Medicine
