摘要
目的前瞻性研究影响肝硬化食管曲张静脉破裂出血的主要危险因素。方法随访未发生过食管曲张静脉出血的57例肝硬化患者1年。采用内镜下无创性食管曲张静脉气囊测压仪检测曲张静脉压，研究终点为出现食管曲张静脉出血。研究食管曲张静脉内镜下表现、食管曲张静脉压力、肝功能分级、肝硬化病因及腹水指标与食管曲张静脉破裂出血的关系。结果1年内34例（59．6％）患者发生首次食管曲张静脉破裂出血。单因素分析显示，食管曲张静脉压力（P=0．001）、曲张静脉直径（P=0．006）、内镜下红色征（P=0．012）与出血风险有关。进一步的多因素Logistic回归分析显示，食管曲张静脉压力是预测首次出血最主要的危险因子（OR=2．817，P=0．003），其受试者工作曲线（ROC）下面积为0．98。预测出血的食管曲张静脉压力截值为25．3mmHg（1mmHg=0．133kPa），其敏感性与特异性均为91％。结论食管曲张静脉压力是预测食管曲张静脉破裂出血的主要危险因素。
Objective To prospectively study the main risk factors of variceal bleeding in cirrhotic patients. Methods Fifty seven patients with liver cirrhosis and esophageal varices who had never experienced variceal bleeding were followed up for 12 months. The patients underwent measurements of esophageal variceal pressure by non-invasive endoscopic balloon technique. The endpoint of the study was the presence of a variceal hemorrhage. The relationship between variceal hemorrhage and endoscopic findings including varices, variceal pressure, Child-Pugh status, ascites, and etiology of cirrhosis was studied. Results Thirty four patients （59.6 %） developed a variceal hemorrhage. In univariate analysis, the level of variceal pressure （P=0. 001）, the size of varices （P=0. 006）, and the endoscopic red color sign on the variceal wall （P= 0. 012） predicted higher risks of variceal hemorrhage. The multiple logistic regression revealed that variceal pressure was a major predictor of the risk for a first variceal bleeding （OR= 2. 817, P= 0. 003）. The area under the receiver operating characteristic （ROC） of variceal pressure for predicting variceal bleeding was 0.98, and the variceal pressure cutoff value was 25.3 mm Hg （1 mm Hg=0. 133 kPa） with both specificity and sensitivity of 91%. Conclusion The level of variceal pressure is a major predictor for variceal bleeding in cirrhotic patients.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2009年第2期86-89,共4页
Chinese Journal of Digestion
基金
安徽省十一五科技攻关课题（7010302208）[志谢感谢美国PonceSchoolofMedicine唐七义副教授提供的帮助]
关键词
胃食管静脉曲张
肝硬化
门静脉压力
Esophageal and gastric varices
Liver cirrhosis
Portal pressure
作者简介
通信作者：许建明，Email：xjm1017@yahoo．com．cn
