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

摘要： 背景　痔病是常见病，虽然阐述其病理机制的研究众多，但是均不能完全解释痔病的临床表现，且尚未在痔病的共性病理变化方面达成共识。既往研究描述了在痔病的病理检查中可以观察到痔组织出血现象，但是对痔组织出血的原因及其在病理发展过程和临床实践中的意义并没有受到重视。目的　观察痔病患者显微镜下痔组织出血情况，并分析其影响因素。方法　选取2014年1月—2016年8月在北京中医药大学东直门医院肛肠科住院的患者。依据病理检查结果中是否发生痔组织出血，将其分为痔组织出血组和无痔组织出血组。回顾性收集患者的基本资料（性别、年龄、病程、肛门手术史、高血压、心血管疾病、脑血管疾病、糖尿病、高脂血症）、临床症状（痔核脱出、便血、肛门瘙痒、肛门潮湿、肛门疼痛）、痔病分度，病理检查结果中的组织慢性炎症表现和血栓情况。分析痔病患者发生痔组织出血影响因素。结果　最终纳入符合研究标准的痔病患者380例，其中痔组织出血302例（79.5%），无痔组织出血78例（20.5%）。痔组织出血组年龄、高血压患病率高于无痔组织出血组，肛门疼痛发生率低于无痔组织出血组（P<0.05）。痔组织出血组中有慢性炎症表现169例（56.0%），无慢性炎症表现133例（44.0%）；无痔组织出血组中有慢性炎症表现26例（33.3%），无慢性炎症表现52例（66.7%）；痔组织出血组慢性炎症表现发生率高于无痔组织出血组（χ2=12.704，P<0.001）。痔组织出血组血栓发生率〔6.3%（19/302）〕低于无痔组织出血组〔23.1%（18/78）〕（χ2=19.873，P<0.001）。多因素Logistic回归分析结果显示，高血压〔OR=3.053，95%CI （1.162，8.020）〕、慢性炎症〔OR=2.449，95%CI （1.407，4.266）〕、血栓〔OR=0.207，95%CI （0.091，0.470）〕是痔病患者发生痔组织出血的影响因素（P<0.05）。结论　显微镜下痔组织出血是痔病主要的病理变化之一，其原因是痔组织损伤，且肛垫损伤可能是痔病的初始病因；年龄、高血压、慢性炎症、血栓是痔病患者发生痔组织出血的影响因素，年龄和高血压病史可以作为外科手术决策的依据。

关键词: 痔, 出血, 病理过程, 炎症, 高血压, 发病年龄