肝硬化合并食管胃静脉曲张患者消化性溃疡出血的特征。
Characteristics of peptic ulcer bleeding in cirrhotic patients with esophageal and gastric varices.
机构信息
Liver Cirrhosis Diagnosis and Treatment Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.
Departement of Internal Medicine, Beijing South Medical District of Chinese PLA General Hospital, No. 1 North Liuli Bridge, Beijing, 100161, China.
出版信息
Sci Rep. 2020 Nov 18;10(1):20068. doi: 10.1038/s41598-020-76530-3.
Upper gastrointestinal bleeding (UGIB) is common in liver cirrhosis. Although esophageal and gastric varices (EGV) is the main bleeding source, there were still a proportion of patients with peptic ulcer bleeding. Thus, this study aimed to analyze the characteristic of variceal bleeding and peptic ulcer bleeding in liver cirrhosis. Cirrhotic patients with confirmed UGIB by urgent endoscopy from July 2012 to June 2018 were enrolled, and classified into peptic ulcer bleeding group (n = 248) and variceal bleeding group (n = 402). Clinical and endoscopic characteristics, therapeutic efficacy and prognosis were evaluated, and independent risk factors for 42-day morality were determined. The mean age and gender ratio of peptic ulcer bleeding group were higher than those in variceal bleeding group (55.58 ± 11.37 vs. 52.87 ± 11.57, P < 0.01; 4.51:1 vs. 2.87:1, P = 0.023). Variceal bleeding group most commonly presented as red blood emesis and coffee grounds (67.16%), while peptic ulcer group primarily manifested as melena (62.10%). Hepatocellular carcinoma was more prevalent in peptic ulcer group (141 vs. 119, P < 0.01). Albumin level in variceal bleeding group was lower higher (P < 0.01), but serum bilirubin, creatinine and prothrombin time were significantly higher (all P < 0.01). Success rate of endoscopic hemostasis for variceal bleeding and peptic ulcer bleeding was 89.05% and 94.35% (P = 0.021). Univariate and multivariate analysis identified prothrombin time (P = 0.041, OR [95% CI] 0.884 [0.786-0.995]), MELD score (P = 0.000, OR [95% CI] 1.153 [1.073-1.240]), emergency intervention (P = 0.002, OR [95% CI] 8.656 [2.219-33.764]), hepatic encephalopathy before bleeding (P = 0.003, OR [95% CI] 8.119 [2.084-31.637]) and hepatic renal syndrome before bleeding (P = 0.029, OR [95% CI] 3.877 [1.152-13.045]) as the independent predictors for 42-day mortality. Peptic ulcer bleeding should be distinguished from variceal bleeding by clinical and endoscopic characteristics.
上消化道出血（UGIB）在肝硬化中很常见。尽管食管和胃静脉曲张（EGV）是主要的出血源，但仍有一部分患者为消化性溃疡出血。因此，本研究旨在分析肝硬化患者中静脉曲张出血和消化性溃疡出血的特征。本研究纳入了 2012 年 7 月至 2018 年 6 月因 UGIB 而行紧急内镜检查的肝硬化患者，并分为消化性溃疡出血组（n=248）和静脉曲张出血组（n=402）。评估了临床和内镜特征、治疗效果和预后，并确定了 42 天死亡率的独立危险因素。消化性溃疡出血组的平均年龄和性别比高于静脉曲张出血组（55.58±11.37 vs. 52.87±11.57，P<0.01；4.51:1 vs. 2.87:1，P=0.023）。静脉曲张出血组最常见的表现为呕血和咖啡渣样便（67.16%），而消化性溃疡组主要表现为黑便（62.10%）。消化性溃疡出血组的肝细胞癌更为常见（141 例 vs. 119 例，P<0.01）。静脉曲张出血组的白蛋白水平较低（P<0.01），但血清胆红素、肌酐和凝血酶原时间明显较高（均 P<0.01）。静脉曲张出血和消化性溃疡出血内镜止血的成功率分别为 89.05%和 94.35%（P=0.021）。单因素和多因素分析确定凝血酶原时间（P=0.041，OR[95%CI]0.884[0.786-0.995]）、MELD 评分（P=0.000，OR[95%CI]1.153[1.073-1.240]）、紧急干预（P=0.002，OR[95%CI]8.656[2.219-33.764]）、出血前肝性脑病（P=0.003，OR[95%CI]8.119[2.084-31.637]）和出血前肝肾综合征（P=0.029，OR[95%CI]3.877[1.152-13.045]）是 42 天死亡率的独立预测因素。消化性溃疡出血应通过临床和内镜特征与静脉曲张出血相鉴别。
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