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伴门静脉栓子的食管胃静脉曲张破裂出血急诊胃镜下硬化术联合组织胶注射术止血失败的危险因素分析

丁鹏鹏 王沧海 李莉 陈建宏 祁小宝 王艳玲 路筝 张文辉 刘红

丁鹏鹏, 王沧海, 李莉, 等. 伴门静脉栓子的食管胃静脉曲张破裂出血急诊胃镜下硬化术联合组织胶注射术止血失败的危险因素分析[J]. 临床肝胆病杂志, 2021, 37(1): 68-72. DOI: 10.3969/j.issn.1001-5256.2021.01.014
引用本文: 丁鹏鹏, 王沧海, 李莉, 等. 伴门静脉栓子的食管胃静脉曲张破裂出血急诊胃镜下硬化术联合组织胶注射术止血失败的危险因素分析[J]. 临床肝胆病杂志, 2021, 37(1): 68-72. DOI: 10.3969/j.issn.1001-5256.2021.01.014
DING PP, WANG CH, LI L, et al. Risk factors for hemostatic failure in emergency gastroscopic sclerotherapy combined with tissue adhesive injection for esophagogastric variceal bleeding with portal vein embolus[J]. J Clin Hepatol, 2021, 37(1): 68-72. DOI: 10.3969/j.issn.1001-5256.2021.01.014
Citation: DING PP, WANG CH, LI L, et al. Risk factors for hemostatic failure in emergency gastroscopic sclerotherapy combined with tissue adhesive injection for esophagogastric variceal bleeding with portal vein embolus[J]. J Clin Hepatol, 2021, 37(1): 68-72. DOI: 10.3969/j.issn.1001-5256.2021.01.014

伴门静脉栓子的食管胃静脉曲张破裂出血急诊胃镜下硬化术联合组织胶注射术止血失败的危险因素分析

DOI: 10.3969/j.issn.1001-5256.2021.01.014
基金项目: 

国家自然科学基金青年科学基金项目 81900505

详细信息
    作者简介:

    丁鹏鹏(1985—),男,主治医师,主要从事肝病、消化内镜方面的研究

    通讯作者:

    刘红,liuhong_sjt@ccmu.edu.cn

  • 利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突,特此声明。
  • 作者贡献声明:丁鹏鹏、陈建宏负责课题设计,资料分析,撰写论文;李莉、祁小宝、王艳玲参与收集数据,修改论文;王沧海、路筝、张文辉、刘红负责拟定写作思路,指导撰写文章,并最后定稿。
  • 中图分类号: R575.2

Risk factors for hemostatic failure in emergency gastroscopic sclerotherapy combined with tissue adhesive injection for esophagogastric variceal bleeding with portal vein embolus

  • 摘要:   目的  探讨急诊胃镜下硬化术(EIS)序贯联合组织胶注射术(HI)在合并门静脉栓子(PVE)的肝硬化食管胃静脉曲张破裂出血(EGVB)治疗中失败的危险因素。  方法  选取2018年1月—2019年12月首都医科大学附属北京世纪坛医院和解放军总医院第五医学中心急诊胃镜治疗的合并PVE的EGVB患者共109例,按照急诊胃镜下止血疗效分为止血失败组(n=28)和止血成功组(n=81),比较两组间的一般资料、胃镜下静脉曲张及出血表现、血液生化指标、Child-Pugh分级及MELD评分,分析其止血失败的危险因素。计量资料两组间比较采用t检验或Mann-Whitney U秩和检验,计数资料两组间比较采用χ2检验,多因素分析采用logisitc回归分析。  结果  止血失败组外周血WBC、TBil、Child-Pugh分级、MELD评分均显著高于止血成功组(统计值分别为Z=3.794、Z=4.751、χ2=40.104、Z=6.412,P值均<0.001),而PTA、Alb、CHE均显著低于止血成功组(统计值分别为t=9.653、Z=3.093、Z=4.092,P值分别为<0.001、0.002、<0.001);其中WBC、PTA、TBil、Alb、Child-Pugh分级为其止血治疗失败的独立危险因素[OR(95%CI)分别为:28.543(1.285~634.113)、0.194(0.045~0.835)、2.197(1.004~4.810)、0.448(0.209~0.961)、5.164(1.307~20.406),P值均<0.05]。  结论  WBC、PTA、TBil、Alb、Child-Pugh分级为急诊EIS序贯联合HI治疗合并PVE的EGVB失败的独立危险因素,术前充分评估并纠正有助于提高止血成功率。
  • 表  1  两组一般资料比较

    项目 成功组(n=81) 失败组(n=28) 统计值 P
    男[例(%)] 55(67.9) 23(82.1) χ2=2.074 0.150
    年龄(岁) 57.44±9.63 55.04±9.00 t=1.160 0.249
    肝硬化病因[例(%)] χ2=2.531 0.112
      病毒性肝炎 71(87.7) 21(75.0)
      非病毒性肝炎 10(12.3) 7(25.0)
    肝硬化病程(年) 7.44(2.00~9.00) 4.39(1.00~6.75) Z=1.894 0.058
    合并肝癌[例(%)] 28(34.6) 14(50.0) χ2=2.092 0.148
    首次出血[例(%)] 35(43.2) 8(28.6) χ2=1.867 0.172
    下载: 导出CSV

    表  2  两组静脉曲张情况比较

    胃镜下表现 成功组(n=81) 失败组(n=28) χ2 P
    静脉曲张程度[例(%)] 2.771 0.096
      重度
      中度
    64(79.0)
    17(21.0)
    26(92.9)
    2(7.1)
    静脉曲张出血部位[例(%)] 4.773 0.092
      食管
      贲门
      胃底
    54(66.7)
    19(23.5)
    8(9.9)
    17(60.7)
    11(39.3)
    0
    胃镜下出血表现[例(%)] 0.131 0.717
      活动性出血1) 46(56.8) 17(60.7)
      其他2) 35(43.2) 11(39.3)
    注:1)活动性出血指静脉曲张喷血、涌血或渗血; 2)其他指曲张静脉有糜烂、血栓及镜下能够见到新鲜血液,并能排除非静脉曲张出血因素。
    下载: 导出CSV

    表  3  两组血液生化指标比较

    项目 成功组(n=81) 失败组(n=28) 统计值 P
    WBC(109/L) 4.29(1.51~5.88) 8.10(3.75~11.03) Z=3.794 <0.001
    Hb(g/L) 92.78(83.50~102.50) 88.50(71.25~99.75) Z=1.467 0.142
    PLT(109/L) 125.44(80.50~131.00) 91.89(50.50~135.75) Z=1.876 0.061
    PTA(%) 76.62±7.40 53.60±17.51 t=9.653 <0.001
    ALT(U/L) 28.05(19.00~35.00) 53.50(20.75~70.50) Z=1.657 0.098
    AST(U/L) 51.11(31.50~57.00) 139.50(32.00~177.50) Z=1.758 0.079
    TBil(μmol/L) 18.83(10.65~19.25) 69.49(19.00~79.80) Z=4.751 <0.001
    Alb(g/L) 32.33(29.00~36.50) 28.11(24.00~33.75) Z=3.093 0.002
    ChE(U/L) 3445(2487~4260) 2327(1579~2772) Z=4.092 <0.001
    Child-Pugh分级[例(%)] χ2=40.104 <0.001
      A级
      B级
      C级
    33(40.7)
    42(51.9)
    6(7.4)
    011(39.3)
    17(60.7)
    MELD评分 8.59(7~8) 14.68(10~17) Z=6.412 P<0.001
    下载: 导出CSV

    表  4  止血疗效影响因素的logistics回归分析

    变量 B SE Wald值 P OR(95%CI)
    WBC 3.351 1.582 4.487 0.034 28.543(1.285~634.113)
    PTA 1.641 0.746 4.846 0.028 0.194(0.045~0.835)
    TBil 0.787 0.400 3.880 0.049 2.197(1.004~4.810)
    Alb 0.802 0.389 4.261 0.039 0.448(0.209~0.961)
    ChE 0.002 0.002 2.180 0.140 0.998(0.994~1.001)
    MELD评分 0.066 0.909 0.005 0.942 1.068(0.180~6.329)
    Child-Pugh分级1)(B级=0,C级=1) 1.642 0.701 5.483 0.019 5.164(1.307~20.406)
    注:1)因止血失败组Child-Pugh A级为0例,仅纳入两组间Child-Pugh B级C级进行比较。
    下载: 导出CSV
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  • 收稿日期:  2020-07-27
  • 修回日期:  2020-09-07
  • 刊出日期:  2021-01-18
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