Colombo E, Casiraghi M A, Minoli G, Prada A, Terruzzi V, Bortoli A, Carnovali M, Gullotta R, Imperiali G, Comin U
Gastrointestinal Unit, Hospital of Garbagnate Milanese, Italy.
Ital J Gastroenterol. 1995 Sep;27(7):345-8.
Two hundred patients affected by liver cirrhosis and oesophageal varices were studied in 9 Gastrointestinal Units in Lombardy (Northern Italy) in order to assess factors possibly related to variceal bleeding. Only patients without any previous episode of gastrointestinal bleeding were included in the prospective evaluation. For each patient demographic data, aetiology of cirrhosis, various clinical and biochemical parameters able to group patients into the three Child-Pugh Classes, endoscopic items for calculation of Beppu's and of NIEC prognostic scores were recorded on computerized cards. Patients were regularly interviewed every three months for one year and underwent an upper gastrointestinal endoscopy at enrollment, after six months and in case of bleeding. Within the twelve-month follow-up period, 29 out of the 200 patients (14%) bled and 52 out of 200 died (26%). In 16 of the 52 patients who died (59% of bleeding patients) death was directly related to gastrointestinal bleeding. Bleeding from oesophageal varices was endoscopically proven in 19/29 patients, in another 9 bleeding was classified as from unknown source and in one patient a bleeding gastric ulcer was diagnosed. Univariate analysis of all the recorded clinical, biochemical and endoscopic parameters, performed by Chi-square method and Fisher exact test showed that the presence of RWM (p < 0.001) was the only factor significantly associated to variceal bleeding within one year. Relationship between size of varices and bleeding was very close to the statistical significance but did not achieve it (p = 0.058).
为了评估可能与静脉曲张出血相关的因素，在意大利北部伦巴第大区的9个胃肠病科对200例肝硬化合并食管静脉曲张患者进行了研究。前瞻性评估仅纳入既往无任何胃肠道出血发作的患者。对于每位患者，将人口统计学数据、肝硬化病因、能够将患者分为三个Child-Pugh分级的各种临床和生化参数、用于计算Beppu和NIEC预后评分的内镜项目记录在计算机卡片上。患者在一年中每三个月定期接受访谈，并在入组时、六个月后以及出血时接受上消化道内镜检查。在十二个月的随访期内，200例患者中有29例（14%）出血，200例中有52例死亡（26%）。在52例死亡患者中的16例（占出血患者的59%），死亡与胃肠道出血直接相关。29例患者中有19例经内镜证实为食管静脉曲张出血，另外9例出血分类为来源不明，1例患者诊断为胃溃疡出血。采用卡方检验和Fisher精确检验对所有记录的临床、生化和内镜参数进行单因素分析，结果显示RWM的存在（p<0.001）是一年内与静脉曲张出血显著相关的唯一因素。静脉曲张大小与出血之间的关系非常接近统计学显著性，但未达到（p = 0.058）。
