肝硬化患者急性静脉曲张出血的内镜干预时机

doi:10.3760/cma.j.cn311367-20230818-00045

科研成果详情

题名	肝硬化患者急性静脉曲张出血的内镜干预时机
其他题名	Timing of endoscopic intervention for acute variceal bleeding in patients with liver cirrhosis
作者	陈卉卉 1; 张文辉 2; 向慧玲 3; 张丽瑶 4; 原丽莉 5; 王省 6; 吴斌 6; 党彤 7; 张国 8; 呼圣娟 9,34; 彭利军 10; 高敏 11; 夏冬丽 12; 李嘉 13; 宋瑛 14; 周希乔 15; 齐兴四 16; 曾景 17; 谭小燕 18; 邓明明 19; 方海明 20; 綦盛麟 21; 何松 22; 贺永锋 23; 叶斌 24; 吴伟25; 邵江波 26; 韦炜 27; 胡建平 28; 雍鑫 29; 何朝晖 30; 暴金伦 31; 张月宁 32; 姬瑞 33; 卜阳 9,34; 晏维 35; 栗红江 36; 黄义飞 6; 祁小龙 1
发表日期	2024-03-15
发表期刊	中华消化杂志影响因子和分区
语种	中文
原始文献类型	Periodical
关键词	急性静脉曲张出血肝硬化急诊内镜干预时机 5 d内治疗失败率住院病死率
其他关键词	Acute variceal bleeding ; Liver cirrhosis ; Timing of emergency endoscopic intervention ; Treatment failure rate within 5 days ; In-hospital mortality
摘要	目的:探讨不同时机行内镜干预对肝硬化合并急性静脉曲张出血(AVB)患者预后的影响。方法:回顾性分析2013年2月至2020年5月来自以东南大学附属中大医院牵头的中国35所三级医院的2 678例肝硬化合并AVB患者的人口统计学和临床数据(包括实验室检查、临床和内镜检查数据)。根据患者接受内镜检查时间分为入院后6 h内行急诊内镜检查(6 h)组(2 383例)和入院后6～12 h行急诊内镜检查(6～12 h)组(295例)。为达到基线平衡(即最小混淆)，对患者进行1∶1倾向评分匹配后，共纳入588例患者，其中6 h组和6～12 h组各294例。比较倾向评分匹配前后6 h组和6～12 h组患者的5 d内治疗失败发生率和住院病死率，并根据出血史与Child-Pugh分级分析倾向评分匹配后6 h组与6～12 h组各因素亚组患者的5 d内治疗失败发生率。采用Kaplan-Meier法和log-rank检验进行组间比较，采用多因素分析探讨5 d内治疗失败的独立影响因素。结果:倾向评分匹配前，6 h组与6～12 h组5 d内治疗失败发生率比较[3.7%(89/2 383)比4.7%(14/295)]，差异无统计学意义[ HR(95%置信区间) 1.19(0.67～2.13)， P0.05]；6 h组与6～12 h组住院病死率比较[2.8%(67/2 383)比2.7%(8/295)]，差异无统计学意义( P0.05)。倾向评分匹配后，6 h组与6～12 h组5 d内治疗失败发生率比较[3.1%(9/294)比4.4%(13/294)]，差异无统计学意义[ HR(95%置信区间) 1.48(0.63～3.45)， P0.05]；6 h组与6～12 h组住院病死率比较[2.0%(6/294)比2.7%(8/294)]，差异无统计学意义( P0.05)。倾向评分匹配后亚组分析结果中，仅6 h组与6～12 h组中Child-Pugh分级C级患者5 d内治疗失败发生率比较[1.8%(1/55)比11.8%(6/51)]，差异有统计学意义[ HR(95%置信区间) 6.89(0.83～57.20)， P＝0.041]。多因素分析结果显示，Child-Pugh分级为C级是肝硬化合并AVB患者5 d内治疗失败的独立影响因素[ HR(95%置信区间) 2.13(1.12～4.03)， P＝0.021]。结论:肝硬化患者在入院后6 h或6～12 h内进行内镜干预的短期预后相当。
其他摘要	Objective:To explore the effects of endoscopic intervention at different times on the prognosis of patients with liver cirrhosis complicated with acute variceal bleeding (AVB).Methods:From February 2013 to May 2020, the demographic and clinical data (including data from laboratory tests and clinical and endoscopic examinations) of 2 678 patients with liver cirrhosis complicated with AVB from 35 tertiary hospitals in China led by Zhongda Hospital Southeast University were retrospectively analyzed. According to the time of endoscopic examination, the patients were divided into emergency endoscopy performed within 6 h after admission group (6 h group) (2 383 cases) and emergency endoscopy performed 6 to 12 h after admission group (6 to 12 h group) (295 cases). After 1 to 1 propensity score matching to achieve baseline balance (minimal confounding), a total of 588 patients were enrolled, with 294 patients each in the 6 h group and the 6 to 12 h group. Treatment failure rate and in-hospital mortality within 5 d were compared between the 6 h group and the 6 to 12 h group before and after propensity score matching. According to the history of bleeding and Child-Pugh classification, the treatment failure rate within 5 d was analyzed in the 6 h group and 6 to 12 h group after propensity score matching. The Kaplan-Meier method and log-rank test were performed for comparison between groups. Multivariate analysis was used to identify the independent influencing factors of treatment failure within 5 days.Results:Before propensity score matching, there was no statistically significant difference in the treatment failure rate within 5 d between the 6 h group and the 6 to 12 h group (3.7%, 89/2 383 vs. 4.7%, 14/295) ( HR (95% confidence interval) 1.19 (0.67 to 2.13), P0.05). There was no statistically significant difference in in-hospital mortality between the 6 h group and the 6 to 12 h group (2.8%, 67/2 383 vs. 2.7%, 8/295, P0.05). After propensity score matching, there was no statistically significant difference in the treatment failure rate within 5 d between the 6 h group and the 6 to 12 h group (3.1%, 9/294 vs. 4.4%, 13/294) ( HR (95% confidence interval) 1.48 (0.63 to 3.45), P0.05). There was no statistically significant difference in in-hospital mortality between the 6 h group and the 6 to 12 h group (2.0%, 6/294 vs. 2.7%, 8/294, P0.05). In the subgroup analysis after propensity score matching, there was only a statistically significant difference in the treatment failure rate within 5 d between the 6 h group and the 6 to 12 h group in patients of Child-Pugh grade C (1.8%, 1/55 vs. 11.8%, 6/51) ( HR (95% confidence interval) 6.89 (0.83 to 57.20), P=0.041). The results of the multivariate analysis revealed that Child-Pugh grade C was an independent influencing factor of treatment failure within 5 d in patients with liver cirrhosis complicated with AVB ( HR (95% confidence interval) 2.13 (1.12 to 4.03), P=0.021). Conclusion:The short-term prognosis of patients with cirrhosis who underwent endoscopic intervention within 6 h or 6 to 12 h after admission is similar.
ISSN	0254-1432
卷号	44 期号:3 页码:156-164
DOI	10.3760/cma.j.cn311367-20230818-00045
页数	9
收录类别	万方 ; 维普 ; CSCD ; ISTIC ; 北大核心
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引用统计
文献类型	期刊论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/214825
专题	附属第一医院附属第一医院_消化内科
作者单位	1.东南大学附属中大医院放射科　超声科　门静脉高压中心，南京　210009; 2.北京市大兴区人民医院消化内科，北京　102699; 3.天津市第三中心医院消化(肝病)科　天津市重症疾病体外生命支持重点实验室　天津市肝胆疾病研究所，天津　300170; 4.沈阳市第六人民医院重症医学科，沈阳　110006; 5.山西白求恩医院消化内科，太原　030032; 6.中山大学附属第三医院消化内科，广州　510630; 7.内蒙古科技大学包头医学院第二附属医院消化科　内蒙古消化病研究所，包头　014031; 8.中山大学附属第一医院广西医院消化内科，南宁　530025; 9.宁夏回族自治区人民医院消化内科，银川　750021; 10.临沂市人民医院消化内科，临沂　276034; 11.浙江大学医学院附属邵逸夫医院消化内科，杭州　310009; 12.重庆大学附属涪陵医院消化内科，重庆　408099; 13.天津市第二人民医院消化内科，天津　301799; 14.西安高新医院消化内科，西安　710075; 15.南京医科大学第一附属医院消化科，南京　210024; 16.青岛大学附属医院消化内科，青岛　264299; 17.广州医科大学附属惠州医院急诊科，惠州　516002; 18.茂名市人民医院消化内科，茂名　525099; 19.西南医科大学附属医院消化内科，泸州　646099; 20.安徽医科大学第二附属医院消化内科，合肥　230601; 21.大连市第六人民医院肝病科，大连　116113; 22.重庆医科大学附属第二医院消化内科，重庆　408599; 23.安康市中心医院消化内科　内镜中心，安康　725099; 24.丽水市中心医院消化内科，丽水　323020; 25.温州医科大学附属第一医院消化内科，温州　325015; 26.镇江市第三人民医院肝病科，镇江　212009; 27.浙江大学医学院附属第二医院消化科，杭州　310009; 28.银川市第一人民医院消化内科，银川　750003; 29.解放军西部战区总医院消化内科，成都　610083; 30.遵义医科大学第五附属(珠海)医院消化内科与内镜科，珠海　519180; 31.山南市人民医院消化内科，山南　856099; 32.首都医科大学附属北京佑安医院肝病与胃肠病学中心，北京　100069; 33.兰州大学第一医院消化内科，兰州　730099; 34.宁夏回族自治区人民医院肝胆外科，银川　750021; 35.华中科技大学同济医学院附属同济医院消化内科，武汉　430101; 36.保定市人民医院肝病科，保定　071030
推荐引用方式 GB/T 7714	陈卉卉,张文辉,向慧玲,等. 肝硬化患者急性静脉曲张出血的内镜干预时机[J]. 中华消化杂志,2024,44(3):156-164.
APA	陈卉卉., 张文辉., 向慧玲., 张丽瑶., 原丽莉., ... & 祁小龙. (2024). 肝硬化患者急性静脉曲张出血的内镜干预时机. 中华消化杂志, 44(3), 156-164.
MLA	陈卉卉,et al."肝硬化患者急性静脉曲张出血的内镜干预时机".中华消化杂志 44.3(2024):156-164.