Tahri Nabil, Amouri Ali, Fekih Habib, El-Euch Faïçal, Krichen Mohamed Salah
Service d'Hépato-Gastroentérologie, CHU Hedi-Chaker, Sfax, Tunisia.
Ann Med Interne (Paris). 2003 Dec;154(8):509-14.
While meteorologic conditions are thought to be related to the incidence of certain cardiac and cerebrovascular events, very little information is available concerning the onset of variceal bleeding. We undertook this study to determine whether there is any correlation between esophageal variceal hemorrhage and several meteorologic and astronomic parameters.
Sixty-seven episodes of bleeding from ruptured esophageal varices observed in 52 patients from southern Tunisia during a 7-Year period were studied retrospectively. All patients underwent endoscopic examination within 24 hours of admission. The date of the event (variceal rupture) was considered--if no stigmates of active bleeding were found at endoscopy--as the day of occurrence of the hematemesis and the day preceding melena. Meteorologic readings (11 parameters) plus moon-cycle, circadian and seasonal distribution of the 67 days of variceal bleeding in comparison with a control period of days randomly selected among 134 days without rupture.
No relationship was found between variceal bleeding and mean atmospheric pressure, daily hours of sunshine, nebulosity, direction and velocity of wind and mean humidity. On the contrary, a significant correlation was observed with the mean temperature (18 degrees C vs 21.16 degrees C; p=0003), rainfall (p<0.01) and stormy weather (p=0.008), the latter being the only parameter retained as an independent factor at multivariate analysis: OR=13.37 (95% CI=1.5-118.5). Furthermore, a negative correlation was found with full moon but only at univariate analysis (p=0.04). The seasonal distribution of variceal bleeding episodes showed the highest percentage during winter with a significant variation at multivariate analysis: OR=3.2 (95% IC=1.6-6.54). Occurrence of variceal bleeding also showed a circadian variation with the higher prevalence night between 6 and 0 PM (p<0.001).
虽然气象条件被认为与某些心脑血管事件的发生率有关，但关于静脉曲张出血的发病情况，可用信息却非常少。我们开展这项研究以确定食管静脉曲张出血与若干气象和天文参数之间是否存在任何关联。
回顾性研究了突尼斯南部52例患者在7年期间发生的67次食管静脉曲张破裂出血事件。所有患者在入院后24小时内接受了内镜检查。如果在内镜检查时未发现活动性出血的迹象，则将事件（静脉曲张破裂）日期视为呕血发生日和黑便前一日。记录了气象读数（11个参数）以及67天静脉曲张出血的月周期、昼夜和季节分布情况，并与从134天无破裂的日子中随机选择的对照期进行比较。
未发现静脉曲张出血与平均气压、每日日照时长、云量、风向和风速以及平均湿度之间存在关联。相反，观察到与平均温度（18摄氏度对21.16摄氏度；p = 0.003）、降雨量（p < 0.01）和暴风雨天气（p = 0.008）存在显著相关性，后者是多变量分析中唯一保留的独立因素：比值比 = 13.37（95%置信区间 = 1.5 - 118.5）。此外，仅在单变量分析中发现与满月呈负相关（p = 0.04）。静脉曲张出血事件的季节分布显示冬季发生率最高，多变量分析时有显著差异：比值比 = 3.2（95%置信区间 = 1.6 - 6.54）。静脉曲张出血的发生也呈现昼夜变化，下午6点至凌晨0点之间发生率较高（p < 0.001）。
