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目的探讨肝储备功能对肝硬化食管静脉曲张破裂出血(esophageal varices bleeding,EVB)风险及预后的评估价值。方法回顾性分析笔者医院2009年9月~2012年2月收住的283例肝硬化食管静脉曲张患者的临床资料。根据入院时有无合并EVB分为出血组(n=168)和非出血组(n=115),比较两组入院当时肝储备功能评估结果,以多因素Logistic回归模型寻找肝硬化并发EVB的危险因素,并对经药物或手术控制出血后的患者随访观察1年,分析不同程度肝储备功能及入院后治疗方式对EVB患者预后的影响。结果出血组的肝储备功能相关因素中总胆固醇、纤维蛋白原均低于非出血组,而吲哚菁绿15分钟滞留率(indocyanine green retention rate at 15 minutes,ICG-R15)、门静脉宽度及脾脏厚度均高于非出血组,差异有统计学意义(P<0.05),上述结果经Logistic回归分析得出总胆固醇、纤维蛋白原、ICG-R15、脾脏厚度是食管静脉曲张破裂出血的独立危险因素,OR值分别为0.561、0.643、1.022、1.045。在分别给予药物及手术治疗的两个治疗组中,ICG-R15在再出血患者及非再出血患者之间有统计学差异(P<0.05),总胆固醇、纤维蛋白原、脾脏厚度在两者之间无统计学差异(P>0.05)。两组1年内再出血率随着ICG-R15程度的上升而增加,同等程度ICG-R15水平,药物治疗组的再出血率大于手术治疗组。结论总胆固醇、纤维蛋白原、ICG-R15、脾脏厚度是肝硬化食管静脉曲张破裂出血的独立危险因素。EVB患者1年内的再出血率随ICG-R15增大而增加,手术治疗组的再出血率低于药物治疗组,EVB患者ICG-R15及治疗方式与预后密切相关,是预后评估的重要指标。
Objective To evaluate the value of hepatic reserve on the risk and prognosis of esophageal varices bleeding (EVB) in cirrhotic patients. Methods The clinical data of 283 patients with esophageal varices in cirrhosis who were admitted to our hospital from September 2009 to February 2012 were retrospectively analyzed. The EVB was divided into hemorrhage group (n = 168) and non-hemorrhage group (n = 115) according to the presence or absence of EVB on admission. The assessment results of liver reserve function in both groups were compared at the time of admission to find out the risk of cirrhosis and EVB by multivariate Logistic regression model Factors and follow-up of patients after drug or surgical control of bleeding were followed up for 1 year to analyze the varying degrees of liver function and post-hospital treatment of prognosis of patients with EVB. Results The total cholesterol and fibrinogen were lower in non-hemorrhagic group than those in non-hemorrhagic group. The indocyanine green retention rate at 15 minutes (ICG-R15), portal vein width and spleen (P <0.05). The above results obtained by Logistic regression analysis of total cholesterol, fibrinogen, ICG-R15, spleen thickness is an independent risk factor for esophageal variceal bleeding , OR values were 0.561,0.643,1.022,1.045 respectively. ICG-R15 showed significant difference (P <0.05) between the two groups treated with drugs and surgical treatment, with no difference between the two groups (P <0.05). The total cholesterol, fibrinogen, No significant difference between (P> 0.05). The rate of rebleeding within one year increased with the increase of ICG-R15, with the same level of ICG-R15. The rate of rebleeding in the drug-treated group was greater than that in the operation-treated group. Conclusion Total cholesterol, fibrinogen, ICG-R15, spleen thickness are independent risk factors of cirrhosis esophageal variceal bleeding. The rate of rebleeding within one year of EVB increased with the increase of ICG-R15. The rate of rebleeding in the operation group was lower than that of the drug-treated group. The ICG-R15 and the treatment mode and prognosis of EVB patients were closely related to prognosis.