埃塞俄比亚贡德尔大学专科医院慢性肝病患者的胃食管静脉曲张出血:基于机构的横断面研究
Gastroesophageal variceal hemorrhage in patients with chronic liver diseases attending university of Gondar Specialized comprehensive hospital in Ethiopia: Institutional based cross-sectional study.
作者信息
Baye Mebratu Libanos, Abay Zenahebezu, Tesfaye Tsebaot, Ahmed Endris, Arage Getachew, Zewude Edget Abebe, Anley Denekew Tenaw
机构信息
Department of Medicine, College of Health Sciences, DebreTabor University, Debre Tabor, Ethiopia.
Department of Medicine, College of Health Sciences, University of Gondar, Gondar, Ethiopia.
出版信息
Heliyon. 2023 Mar 31;9(4):e15133. doi: 10.1016/j.heliyon.2023.e15133. eCollection 2023 Apr.
INTRODUCTION
Rupture and bleeding from Gastroesophageal Varices (GEVs) are major complications among patients with chronic liver disease (CLD) and are associated with a high mortality rate. Hence, identifying factors of Gastroesophageal Variceal Hemorrhage (GEVH) is essential for the management and prevention of this fatal outcome.
OBJECTIVE
To assess the prevalence of GEVH and its associated factors among patients with CLD in Northwest Ethiopia.
METHODS
An institutional based cross-sectional study design was employed on a total of 262 patients. The data was entered into Epi-Data version 3.1, and then exported and analyzed using STATA version 14. The distribution of variables was checked using kolmogorov-smirnov test. Bivariable logistic regression model was fitted to select variables for multivariable analysis. In the final model, adjusted odds ratio with 95% confidence level and P-value less than 0.05 were used to assess degree of association.
RESULTS
The mean age of the study subjects was found to be 37.76 years (SD ± 11.62). The prevalence of GEVH was found to be 52% (95% CI: 49.6-54.2). Patients with grade F2 and F3 varices have 3.41 times (AOR: 3.41, 95% CI: 2.33-4.74) and 3.33 times (AOR: 3.33, 95% CI: 2.55-4.12) higher odds of bleeding, respectively. Patients not taking beta blocker have 2.38 times (AOR: 2.38, 95% CI: 1.82-3.90) increased odds of bleeding. Patients with more than three years of duration of illness have 2 times (AOR: 2.19, 95% CI: 1.39-3.99) increased odds of bleeding. Patients with platelet number less than 50,000/μl have 3.46 times (AOR: 3.46, 95% CI: 2.55-4.17) higher odds of bleeding.
CONCLUSION
GEVH is found to be high in patients with CLD seen at university of Gondar Hospital. Higher grade of varices, non-use of beta blockers, presence of infection, platelet number and age are associated with higher occurrence of bleeding, pointing the possibility of averting this fatal complication, for most of the identified factors are preventable.
引言
胃食管静脉曲张(GEV)破裂出血是慢性肝病(CLD)患者的主要并发症,且死亡率很高。因此,识别胃食管静脉曲张出血(GEVH)的相关因素对于管理和预防这一致命后果至关重要。
目的
评估埃塞俄比亚西北部CLD患者中GEVH的患病率及其相关因素。
方法
采用基于机构的横断面研究设计,共纳入262例患者。数据录入Epi-Data 3.1版本,然后导出并使用STATA 14版本进行分析。使用柯尔莫哥洛夫-斯米尔诺夫检验检查变量分布。采用双变量逻辑回归模型选择用于多变量分析的变量。在最终模型中,使用95%置信水平的调整比值比和小于0.05的P值来评估关联程度。
结果
研究对象的平均年龄为37.76岁(标准差±11.62)。GEVH的患病率为52%(95%置信区间:49.6-54.2)。F2级和F3级静脉曲张患者出血几率分别高3.41倍(调整后比值比:3.41,95%置信区间:2.33-4.74)和3.33倍(调整后比值比:3.33,95%置信区间:2.55-4.12)。未服用β受体阻滞剂的患者出血几率增加2.38倍(调整后比值比:2.38,95%置信区间:1.82-3.90)。病程超过三年的患者出血几率增加2倍(调整后比值比:2.19,95%置信区间:1.39-3.99)。血小板计数低于50,000/μl的患者出血几率高3.46倍(调整后比值比:3.46,95%置信区间:2.55-4.17)。
结论
在贡德尔大学医院就诊的CLD患者中,GEVH的患病率较高。静脉曲张等级较高、未使用β受体阻滞剂、存在感染、血小板计数和年龄与出血发生率较高相关,这表明对于大多数已识别的因素而言,由于它们是可预防的,因此有可能避免这一致命并发症。
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