摘要
背景 门静脉血栓(PVT)和消化道出血均是肝硬化患者的并发症,且PVT可加重消化道出血的风险,但两者的治疗相互矛盾,是临床工作的又一难题.目的 探讨肝硬化PVT形成患者并发消化道出血的临床特点及危险因素.方法 回顾性收集2016-10-01-2021-09-30在昆明医科大学第一附属医院住院且诊断为肝硬化PVT患者279例,根据本次入院有无呕血、黑便的消化道出血症状将患者分为出血组(n=127)和非出血组(n=152).对比两组一般资料、并发症、实验室及影像学检查、手术史等相关资料的差异.采用多因素Logistic回归分析探讨肝硬化PVT患者并发消化道出血的影响因素.结果 本研究回顾性调查5 807例肝硬化患者,其中合并PVT患者350例,PVT发生率为6.0%.279例肝硬化PVT患者中肝功能Child B级并发PVT最常见[146例(52.3%)].出血组和非出血组病因、血管受累情况、黄疸、门静脉主干内径、食管胃静脉曲张、白细胞计数(WBC)、血尿素氮(BUN)、血红蛋白(Hb)、血细胞容积(HCT)、总胆红素(TBiL)、纤维蛋白原(FIB)、腹腔手术史比较,差异均有统计学意义(P<0.05).多因素Logistic回归分析结果显示,WBC升高(OR=2.555,95%CI=1.318～6.542)、HCT下降(OR=0.511,95%CI=0.247～0.925)、FIB下降(OR=0.085,95%CI=0.005～0.661)、累及肠系膜上静脉血栓(OR=27.873,95%CI=1.452～1 335.715)是肝硬化PVT患者并发消化道出血的独立危险因素(P<0.05).结论 WBC升高、HCT下降、FIB下降、累及肠系膜上静脉血栓是肝硬化PVT患者并发消化道出血的独立危险因素,应实行早期干预以改善预后.
Abstract
Background Both portal vein thrombosis(PVT)and gastrointestinal bleeding are complications in patients with liver cirrhosis,and PVT can aggravate the risk of gastrointestinal bleeding,but the conflicting treatment of both is another challenge in clinical work.Objective To investigate the clinical characteristics and risk factors of concomitant gastrointestinal bleeding in patients with PVT in liver cirrhosis.Methods A total of 279 patients diagnosed with PVT in liver cirrhosis at the First Affiliated Hospital of Kunming Medical University from 2016-10-01 to 2021-09-30 were retrospectively collected and divided into the bleeding group(n=127)and non-bleeding group(n=152)according to the presence of gastrointestinal bleeding symptoms of hematemesis and melena in this admission.The differences in general information,complications,laboratory and imaging tests,surgical history and other relevant information between the two groups were compared.Multivariate Logistic regression analysis was used to explore the influencing factors of the complications of gastrointestinal bleeding in cirrhotic patients with PVT.Results A total of 5 807 patients were retrospectively investigated in the study,including 350 patients combined with PVT with a incidence of 6.0%.PVT was most common in 279 cirrhotic patients with PVT complicated by liver function Child B grade[146(52.3%)].There were significant differences in etiology,vascular involvement,jaundice,internal diameter of main portal vein,gastroesophageal varices,white blood cell(WBC),blood urea nitrogen(BUN),hemoglobin(Hb),hematocrit(HCT),total bilirubin(TBiL),fibrinogen(FIB),and history of laparotomy between the bleeding group and non-bleeding group(P<0.05).Multivariate Logistic regression analysis showed that elevated WBC level(OR=2.555,95%CI=1.318-6.542),decreased HCT level(OR=0.511,95%CI=0.247-0.925),decreased FIB level(OR=0.085,95%CI=0.005-0.661),and involvement of superior mesenteric vein thrombosis(OR=27.873,95%CI=1.452-1 335.715)were independent risk factors for concomitant gastrointestinal bleeding in cirrhotic patients with PVT(P<0.05).Conclusion Elevated WBC level,decreased HCT level,decreased FIB level and involvement of superior mesenteric vein thrombosis are independent risk factors for gastrointestinal bleeding in cirrhotic patients with PVT,and early intervention should be implemented to improve the prognosis.
维普
万方数据