中国全科医学 ›› 2023, Vol. 26 ›› Issue (14): 1745-1752.DOI: 10.12114/j.issn.1007-9572.2022.0730

所属专题: 消化系统疾病最新文章合辑

• 论著 • 上一篇    下一篇

食管胃底静脉曲张破裂出血对肝硬化患者1年死亡结局的影响及相关因素研究

喻雪珂1, 黎孟玲2, 彭思远2, 申月明2, 梁纶熙2,*(), 曾亚2,*()   

  1. 1.410208 湖南省长沙市,湖南中医药大学研究生院
    2.410004 湖南省长沙市,南华大学附属长沙中心医院消化内科
  • 收稿日期:2022-06-23 修回日期:2022-12-05 出版日期:2023-05-15 发布日期:2023-01-18
  • 通讯作者: 梁纶熙, 曾亚

  • 作者贡献:喻雪珂参与文章构思与设计、数据收集与管理、原稿写作;黎孟玲、彭思远、申月明参与文章构思与设计、数据收集与管理、论文修订;梁纶熙参与文章构思与设计、统计分析、审查和编辑写作;曾亚负责文章构思与设计、文章的质量控制及审校。
  • 基金资助:
    国家自然科学基金青年基金项目(82103151); 湖南省自然科学基金青年基金项目(2020JJ5609); 长沙市科技计划项目(kq2004161); 湖南中医药大学研究生创新课题项目(2021CX31)

Influence of Gastroesophageal Variceal Bleeding on One-year Mortality and Associated Factors in Patients with Liver Cirrhosis

YU Xueke1, LI Mengling2, PENG Siyuan2, SHEN Yueming2, LIANG Lunxi2,*(), ZENG Ya2,*()   

  1. 1. Graduate School, Hunan University of Chinese Medicine, Changsha 410208, China
    2. Department of Gastroenterology, the Affiliated Changsha Central Hospital, University of South China, Changsha 410004, China
  • Received:2022-06-23 Revised:2022-12-05 Published:2023-05-15 Online:2023-01-18
  • Contact: LIANG Lunxi, ZENG Ya

摘要: 背景 食管胃底静脉曲张破裂出血(EGVB)是肝硬化常见且凶险的并发症之一,而EGVB能否影响肝硬化患者1年的死亡结局尚不完全清楚。目的 探讨EGVB对肝硬化患者1年死亡结局的影响及相关因素分析,为肝硬化患者的随访提供依据。方法 选取2015年1月至2021年5月在南华大学附属长沙中心医院就诊的肝硬化患者,根据患者就诊时有无合并EGVB分为EGVB组和未出血组,并对患者进行常规随访,随访终点为患者因肝硬化死亡或1年随访时间结束。采用Logistic回归分析筛选肝硬化患者1年死亡结局的影响因素,通过1∶2倾向性得分匹配(PSM)均衡混杂因素,利用Logistic回归分析探讨EGVB组和未出血组1年死亡结局的影响因素。结果 共纳入肝硬化患者812例,其中EGVB组158例(19.5%),1年死亡率为13.3%(21/158);未出血组654例(80.5%),1年死亡率为13.9%(91/654),两组患者1年死亡率比较,差异无统计学意义(P>0.05)。匹配前多因素Logistic回归分析结果显示,血清钠〔OR=0.95,95%CI(0.90,0.99)〕、白蛋白〔OR=0.95,95%CI(0.91,0.99)〕水平升高是肝硬化患者1年死亡的保护因素(P<0.05),年龄增高〔OR=1.04,95%CI(1.02,1.06)〕、肝性脑病(3~4期)〔OR=3.72,95%CI(1.21,11.37)〕是肝硬化患者1年死亡的危险因素(P<0.05)。PSM后获得EGVB组145例及未出血组290例,两组1年死亡率均为12.4%(18/145、36/290),两组患者1年死亡率比较,差异无统计学意义(P>0.05)。匹配后多因素Logistic回归分析结果表明,尿素氮水平升高〔OR=1.15,95%CI(1.02,1.29)〕是EGVB组患者1年死亡的独立危险因素(P<0.05),年龄增高〔OR=1.09,95%CI(1.04,1.14)〕、中性粒细胞计数/淋巴细胞计数(NLR)水平升高〔OR=1.09,95%CI(1.00,1.18)〕是未出血组患者1年死亡的独立危险因素(P<0.05)。结论 EGVB事件发生与否对肝硬化患者1年死亡率无显著影响,但两组患者1年死亡结局的危险因素存在差异,EGVB组患者1年死亡的独立危险因素为尿素氮水平升高,而未出血组患者1年死亡的独立危险因素为年龄增高和NLR水平升高,这为肝硬化患者的临床随访提供了新的参考。

关键词: 肝硬化, 食管和胃静脉曲张, 食管胃底静脉曲张破裂出血, 预后, 倾向性得分匹配, 影响因素分析

Abstract:

Background

Esophageal and gastric varices bleeding (EGVB) is one of the most common and dangerous complications of liver cirrhosis. However, whether EGVB affects the one-year mortality of patients with liver cirrhosis remains unclear.

Objective

To explore the influence of EGVB on one-year mortality and influencing factors in patients with liver cirrhosis, providing guidance for follow-up for these patients.

Methods

This study selected liver cirrhosis patients who were admitted to the Affiliated Changsha Central Hospital, University of South China from January 2015 to May 2021. The patients were divided into EGVB group and non-bleeding (control group) by the prevalence of EGVB at the first consultation. One-year routine follow-up was conducted with them until the date of death from liver cirrhosis or the termination follow-up day. Logistic regression analysis was conducted for screening the factors affecting one-year mortality. Furthermore, the covariates between the two groups were matched in a 1∶2 ratio using propensity score matching (PSM) . Then, Logistic regression analyses were applied to identify and compare the influencing factors of one-year mortality in the groups.

Results

Among the 812 patients enrolled, 158 (19.5%) were diagnosed with EGVB, and the other 654 (80.5%) had no EGVB. The one-year mortality of the EGVB and control groups was 13.3% (21/158) and 13.9% (91/654) , respectively, showing no significant difference (P>0.05) . Before PSM, multivariate Logistic regression analysis showed that elevated serum sodium level〔OR=0.95, 95%CI (0.90, 0.99) 〕 and albumin level [OR=0.95, 95%CI (0.91, 0.99) 〕 were associated with a decreased risk of one-year mortality (P<0.05) , while older age〔OR=1.04, 95%CI (1.02, 1.06) 〕 and hepatic encephalopathy (grade Ⅲ or Ⅳ) 〔OR=3.72, 95%CI (1.21, 11.37) 〕were associated with an increased risk (P<0.05) . After PSM, the one-year mortality was the same in EGVB group (n=145) and control group (n=290) 〔12.4% (18/145) vs 12.4% (36/290) 〕, showing no significant difference (P>0.05) . Moreover, elevated blood urea nitrogen (BUN) 〔OR=1.15, 95%CI (1.02, 1.29) 〕 was an independent risk factor for one-year mortality in EGVB group (P<0.05) , while older age〔OR=1.09, 95%CI (1.04, 1.14) 〕 and elevated neutrophil-to-lymphocyte ratio (NLR) 〔OR=1.09, 95%CI (1.00, 1.18) 〕 acted as independent risk factors for one-year mortality in the control group (P<0.05) .

Conclusion

EGVB had no obvious association with one-year mortality in liver cirrhosis patients. But there were considerable discrepancies in the risk factors affecting one-year mortality between the two groups. Elevated BUN was the independent risk factor for one-year mortality in the EGVB group, while older age and elevated NLR were independent risk factors for one-year mortality in the control group. These results provide a new reference for clinical follow-up and treatment of patients with liver cirrhosis.

Key words: Liver cirrhosis, Esophageal and gastric varices, Esophageal and gastric varices bleeding, Prognosis, Propensity score matching, Root cause analysis