唐山地区肝硬化并发上消化道出血的病因及临床特点分析

杨美荣; 刘斌; 张国顺; 尚华; 吴贵恺; 高宝霞

doi:10.3969/j.issn.1001-5256.2017.03.016

唐山地区肝硬化并发上消化道出血的病因及临床特点分析

DOI: 10.3969/j.issn.1001-5256.2017.03.016

1. 华北理工大学附属医院血液内科
2. 华北理工大学附属医院消化内科
3. 唐山市传染病医院
4. 唐山市工人医院
5. 开滦集团有限责任公司医院

基金项目:

国家自然科学基金项目(81370477)；

详细信息

中图分类号: R575.2;R573.2
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出版历程
- 出版日期: 2017-03-20

Causes and clinical features of liver cirrhosis complicated by upper gastrointestinal bleeding in Tangshan, China

Department of Hematology, The Affiliated Hospital of North China University of Science and Technology

Research funding:

摘要

摘要: 目的分析唐山地区近5年来肝硬化并发上消化道出血（UGH）的病因及临床特点,为临床治疗提供参考。方法抽取2011年1月-2016年1月于华北理工大学附属医院、唐山市传染病医院、唐山市工人医院和开滦集团有限责任公司医院住院的肝硬化并发UGH患者共计462例,所有患者均行胃镜检查明确出血病因。研究出血病因与肝功能Child-Pugh分级之间的关系。计数资料组间比较用χ2检验。结果肝硬化并发UGH的病因中,食管胃底静脉曲张破裂出血占52.16%;门静脉高压性胃病占27.71%;肝源性溃疡占11.04%;急性胃黏膜病变占4.11%;混合型占3.25%;其他占1.73%。不同病因患者之间,肝功能ChildPugh B级、C级和A级相比较,差异有统计学意义（χ2=30.12,P=0.007）。结论肝硬化并发UGH的病因中,食管胃底静脉曲张破裂出血所占的比例最高,其次为门静脉高压性胃病。出血病因与肝功能Child-Pugh分级具有一定关系。
- 肝硬化 /
- 胃肠出血 /
- 临床特点
Abstract: Objective To investigate the causes and clinical features of liver cirrhosis complicated by upper gastrointestinal bleeding in Tangshan, China in the past 5 years, and to provide a reference for clinical treatment.Methods A total of 462 patients with liver cirrhosis complicated by upper gastrointestinal bleeding who were hospitalized in The Affiliated Hospital of North China University of Science and Technology, Tangshan Municipal Hospital of Infectious Diseases, Tangshan Workers' Hospital, and The Affiliated Hospital of Kailuan Group Limited Liability Corporation were enrolled, and all the patients underwent gastroscopy to clarify the cause of bleeding.The association between the cause of bleeding and Child-Pugh class was analyzed.The chi-square test was used for comparison of categorical data.Results Among the causes of liver cirrhosis complicated by upper gastrointestinal bleeding, esophagogastric variceal bleeding, portal hypertensive gastropathy, hepatogenic ulcer, acute gastric mucosal lesion, and mixed type accounted for 52.16%, 27.71%, 11.04%, 4.11%, and 3.25%, respectively, and other causes accounted for 1.73%.There were significant differences in Child-Pugh class between the patients with different causes (χ2=30.12, P=0.007) .Conclusion Among the causes of liver cirrhosis complicated by upper gastrointestinal bleeding, esophagogastric variceal bleeding is the most common one, followed by portal hypertensive gastropathy.The cause of bleeding is associated with Child-Pugh class.
- liver cirrhosis /
- gastrointestinal hemorrhage /
- clinical features

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参考文献(17)

[1]AMITRANO L, GUARDASCIONE MA, MANGUSO F, et al.The effectivness of current acute variceal bleed treatments in unselected cirrhotic patients:refining short-term prognosis and risk factors[J].Am J Gastroenterol, 2012, 107 (12) :1872-1878.

[2]Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention andtreatment for chronic hepatitis B:a 2015 update[J].J Clin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960.

[3]Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for hepatitis C:a 2015 update[J].J Clin Hepatol, 2015, 31 (12) :1961-1979. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.丙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1961-1979.

[4] Fatty Liver and Alcoholic Liver Disease Study Group of the Chinese Liver Disease Association, Chinese Medical Association.Guidelines for prevention and treatment of alcoholic liver disease (revised version 2010) [J].J Clin Hepatol, 2010, 26 (3) :229-232. (in Chinese) 中华医学会肝病学分会脂肪肝和酒精性肝病学组.酒精性肝病诊疗指南 (2010年修订版) [J].临床肝胆病杂志, 2010, 26 (3) :229-232.

[5]Chinese Society of Digestive Endoscopy.A scheme for endoscopic diagnosis and treatment of esophageal and gastric varices[J].Chin J Dig Endosc, 2000, 17 (4) :498. (in Chinese) 中华消化内镜学分会.食管胃底静脉曲张内镜下诊断和治疗规范试行方案[J].中华消化内镜杂志, 2000, 17 (4) :498.

[6]NG NB, KARTHIK SV, AW MM, et al.Endoscopic evaluation in children with end-stage liver disease-associated portal hypertension awaiting liver transplant[J].J Pediatr Gastroenterol Nutr, 2016, 63 (3) :365-369.

[7]WU CS, ZHANG L, ZHOU W, et al.A clinical observation of hepatic vein pressure gradient and flow rate after Octreotide treatment of bleeding esophageal varices[J].Chin J Clin Pharmacol Ther, 2015, 20 (4) :441-444. (in Chinese) 吴春松, 张玲, 周玮, 等.奥曲肽治疗对食管胃底静脉曲张出血的肝静脉压力梯度及血流速度的影响[J].中国临床药理学与治疗学, 2015, 20 (4) :441-444.

[8]LIU B, ZHANG GS, YANG MR, et al.Risk factors for gastroesophageal variceal bleeding and portal vein thrombosis in patients with liver cirrhosis[J].World Chin J Dig, 2016, 24 (18) :2892-2897. (in Chinese) 刘斌, 张国顺, 杨美荣, 等.肝硬化并发食管胃底静脉曲张破裂出血与门静脉血栓形成的危险因素[J].世界华人消化杂志, 2016, 24 (18) :2892-2897.

[9]YANG MR, ZHANG GS, LIU B, et al.Analysis of the influence factors of cirrhosis complicated with upper gastrointestinal hemorrhage[J].Clin Med China, 2016, 32 (3) :235-238. (in Chinese) 杨美荣, 张国顺, 刘斌, 等.肝硬化患者并发上消化道出血的影响因素分析[J].中国综合临床, 2016, 32 (3) :235-238.

[10]GAO CG, XIE F, FENG YD.Effect of somatostatin combined with pantoprazole in treatment of liver cirrhosis with upper gastrointestinal hemorrhage[J].J Clin Hepatol, 2016, 32 (2) :284-287. (in Chinese) 高成广, 谢峰, 冯亚东.生长抑素联合泮托拉唑治疗肝硬化合并上消化道出血的效果观察[J].临床肝胆病杂志, 2016, 32 (2) :284-287.

[11]HOU Y.The clinical comparison of cirrhosis patients with different etiological upper digestive tract hemorrhage[J].J Clin Exp Med, 2015, 14 (12) :999-1001. (in Chinese) 侯昀.肝硬化不同病因上消化道出血患者的临床对比[J].临床和实验医学杂志, 2015, 14 (12) :999-1001.

[12]MAROT A, TREPO E, DOERIG C, et al.Liver stiffness and platelet count for identifying patients with compensated liver disease at low risk of variceal bleeding[J].Liver Int, 2016, 11 (18) :1428-1431.

[13]LI XL, CHEN MS, GAN QR, et al.Risk factors for antibiotic prophylaxis failure in patients with liver cirrhosis and upper gastrointestinal bleeding[J].J Clin Hepatol, 2016, 32 (2) :288-291. (in Chinese) 李孝楼, 陈明胜, 甘巧蓉, 等.肝硬化上消化道出血预防性抗感染治疗失败的影响因素[J].临床肝胆病杂志, 2016, 32 (2) :288-291.

[14] WU KC.Interpretation of experts'consensus on non variceal upper gastrointestinal bleeding in Asia Pacific Region (three) :Remedial measures for endoscopic hemostasis[J].Chin J Dig, 2012, 32 (2) :82-83. (in Chinese) 吴开春.亚太地区非静脉曲张性上消化道出血专家共识意见解读 (三) :内镜止血的补救措施[J].中华消化杂志, 2012, 32 (2) :82-83.

[15]TOUARSA F, NASSAR I, AJANA A, et al.Upper gastrointestinal bleeding in portal hypertensive gastropathy reveals a wandering spleen[J].Presse Med, 2016, 45 (10) :935-937.

[16]HANAFY AS, EI HAWARY AT.Efficacy of argon plasma coagulation in the management of portal hypertensive gastropathy[J].Endosc Int Open, 2016, 4 (10) :e1057-e1062.

[17]ACHIM AC, VESA SC, DUMITRU E.The efficacy of virtual chromoendoscopy in the diagnosis of portal hypertensive gastropathy[J].J Gastrointestin Liver Dis, 2016, 25 (3) :289-293.

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