关键词: 痔, 出血, 病理过程, 炎症, 高血压, 发病年龄

Abstract: Background　Hemorrhoidal disease（HD） is a common proctologic condition in the general population.There are many studies on exploration of its pathological mechanism，but its clinical manifestations cannot be fully explained and there is no consensus on its common pathological changes.Previous studies have demonstrated that tissue hemorrhage can be observed in pathological examination of hemorrhoids，but the causes of tissue hemorrhage and its important meaning in pathological development and clinical practice were underestimated.Objective　To explore the prevalence and influencing factors of hemorrhoidal hemorrhage observed with fluorescence microscopy in hemorrhoidal disease patients.Methods　From January 2014 to August 2016，the inpatients from Department of Anorectal Surgery，Dongzhimen Hospital，Beijing University of Chinese Medicine，were enrolled consecutively.They were divided into tissue hemorrhage and non-tissue hemorrhage groups according to pathological results.The data were collected retrospectively，including basic profile （sex，age，course of disease，history of anal operation，hypertension，cardiovascular disease，cerebrovascular disease，diabetes，hyperlipidemia），clinical symptoms （prolapse of hemorrhoids，hematochezia，pruritus of anus，dampness of anus，and pain of anus），classification of hemorrhoids，pathologically detected chronic inflammation and thrombosis.Multivariate Logistic regression analysis was performed to analyze the influencing factors of hemorrhoidal hemorrhage.Results　380 patients were finally included，including 302 （79.5%） in tissue hemorrhage group and 78 （20.5%） in non-tissue hemorrhage group.Tissue hemorrhage group showed greater average age and higher prevalence of hypertension，and lower prevalence of anal pain compared with non-tissue hemorrhage group （P<0.05）.The prevalence of non-chronic inflammation was 44.0%（133/302） and 66.7%（52/78） in tissue hemorrhage and non-tissue hemorrhage groups，respectively.The prevalence of chronic inflammation in tissue hemorrhage group was 56.0%（169/302），which was higher than that 〔33.3%（26/78）〕 of non-tissue hemorrhage group（χ2=12.704，P<0.001）.The prevalence of thrombus in tissue hemorrhage group 〔6.3%（19/302）〕 was lower than that〔23.1%（18/78）〕 in non-tissue hemorrhage group（χ2=19.873，P<0.001）.Multivariate Logistic regression analysis showed that hypertension〔OR=3.053，95%CI（1.162，8.020）〕，chronic inflammation〔OR=2.449，95%CI（1.407，4.266）〕，and thrombus〔OR=0.207，95%CI（0.091，0.470）〕 were associated with hemorrhoidal hemorrhage of HD （P<0.05）.Conclusion　Tissue hemorrhage is one of the major pathological changes of hemorrhoids，which is caused by damage to hemorrhoid tissue，and the initial cause may be damage of anal cushion.Age，hypertension，chronic inflammation and thrombus are the influencing factors of tissue hemorrhage of HD.Age and hypertension history may be used as the supplemental basis of surgical decision-making for hemorrhoids patients.

Key words: Hemorrhoids, Hemorrhage, Pathologic processes, Inflammation, Hypertension, Age of onset