摘要
【摘要】目的探讨食管静脉曲张择期行内镜下静脉曲张套扎术（EVL）后早期再出血者的危险因素，并评估早期再出血者的远期预后。方法对198例肝硬化合并食管静脉曲张择期行EVL二级预防患者进行回顾性研究，26例EVL术后6周内发生再出血事件者纳人早期再出血组，其余172例纳入对照组，对比分析可能预测EVL术后发生早期再出血的危险因素，利用生存分析法比较两组患者远期预后，并进一步分析死亡原因。结果对比分析显示肝功能Child—Pugh分级（P=0．016）、肝功能Child—Pugh评分（P=0．012）、术前总胆红素水平（P=0．001）在早期再出血组和对照组间差异有统计学意义；进一步多因素分析发现术前总胆红素水平升高是EVL术后发生早期再出血的独立危险因素（OR=2．02，95％CI：1．04—4．14，P=0．008）。早期再出血组出血相关的死亡占66．7％（10／15），对照组仅占13．6％（6／44），差异有统计学意义（P〈0．01）；Kaplan—Miere生存分析显示，早期再出血组5年累积生存率为25．3％，对照组为67．8％，差异亦有统计学意义（P〈0．01）。结论食管静脉曲张择期EVL术后发生早期再出血患者的远期预后较差，而术前总胆红素水平较高可能提示术后发生早期再出血。
Objective To evaluate the risk factors for early rebleeding （ERB） after elective endo- scopic variceal ligation （EVL） in cirrhotic patients and the influence of ERB on the long-term survival. Methods A total of 198 cirrhotic patients who received elective EVL were retrospectively evaluated. Twen- ty-six patients rebleeded within 6 weeks after initial EVL and were assigned to the ERB group. One hundred and seventy-two other cirrhotic patients were assigned to the control group. Multivariate analysis was used to define the high risk factors of ERB. A Kaplan-Meier analysis was performed to evaluate the cumulative sur- vival rates between two groups. Results The Child-Pugh classification （ P = 0. 016 ）, Child-Pugh scores （P =0. 012）, and the total bilirubin （P = 0. 001 ） were significantly different between ERB and control group. Multivariate analysis showed total bilirubin was the only independent risk factor of ERB （ OR = 2.02, 95%CI： 1.04-4.04, P = 0.008）. The proportional mortality indicator of bleeding-related deaths was 66. 7% （10/15） in ERB group and 13.6% （6/44） in control group （P 〈0. 01 ）. The five-year cumulative survival rate of the control-group was significantly higher than that of the rebleeding group （ 67. 8% vs. 25.3%, P 〈 0. Ol ）. Conclusion Cirrhotic patients with ERB after elective EVL have a poor prognosis. High level of total bilirubin may predict ERB.
出处
《中华消化内镜杂志》
2013年第12期668-670,共3页
Chinese Journal of Digestive Endoscopy
基金
国家自然科学基金资助（81171444）
