摘要
目的:综合分析食管静脉曲张套扎术(endoscopic variceal ligation,EVL)后早期再出血的危险因素,为制定相关预防措施提供临床依据.方法:应用Meta分析的方法,对有关食管静脉曲张套扎术后早期再出血危险因素相关的7篇文献进行综合分析,计算各个可疑危险因素的合并比值比(odds ratio,OR)或加权均数差(weighted mean difference,WMD)及其95%可信区间(95%CI).结果:Grade分级重度(OR=0.04,95%CI:0.02,0.08)、Child-Pugh分级C(OR=0.03,95%CI:0.01,0.07)、腹水量(中量-大量)(OR=0.00,95%CI:0.00,0.01)、门静脉血栓(OR=0.12,95%CI:0.07,0.22)、既往有糖尿病病史(OR=0.36,95%CI:0.18,0.72)为EVL术后早期再出血的危险因素;而Grade分级中度(OR=17.53,95%CI:8.51,36.12)、ChildPugh分级A(OR=4.24,95%CI:2.73,6.58)或B(OR=3.86,95%CI:2.55,5.85)、腹水量(无-少量)(OR=245.37,95%CI:108.35,555.64)、门静脉宽度小(WMD=-2.45,95%CI:-3.92,-0.99)、曲张静脉根数少(W M D=-1.37,95%CI:-1.72,-1.01)、结扎静脉根数少(WMD=-1.72,95%CI:-1.95,-1.50)、血红蛋白含量高(WMD=13.72,95%CI:2.35,25.09)、凝血酶原时间短(WMD=-3.54,95%CI:-4.84,-2.24)、丙氨酸氨基转移酶数值低(W M D=-6.48,95%CI:-11.59,-1.36)、总胆红素含量低(WMD=-8.01,95%CI:-12.04,-3.98)、凝血酶原活动度高(WMD=11.03,95%CI:6.09,15.96)、套扎所用皮圈数目少(WMD=-1.49,95%CI:-1.64,-1.33)为EVL术后早期再出血的保护因素;Grade分级轻度与EVL术后早期再出血关系不显著.结论:通过改善肝功能Child-Pugh分级C级、减少腹水量、改善凝血功能等方法,可减少EVL术后早期再出血的风险.
AIM： To analyze risk factors for early rebleeding after endoscopic variceal ligation（EVL）to provide evidence for clinical use of preventive measures.METHODS： Seven papers reporting risk factors for early rebleeding after EVL were analyzed by meta-analysis.Pooled odds ratio（OR）,weighted mean difference（WMD）and 95% confidence interval（CI）were calculated.RESULTS： Severe grade of esophageal varices（OR=0.04,95%CI： 0.02,0.08）,Child-Pugh classification C（OR=0.03,95%CI： 0.01,0.07）,presence of a moderate to large amount of ascites（OR=0.00,95%CI： 0.00,0.01）,thrombus of the portal vein（OR=0.12,95%CI： 0.07,0.22）,and a history of diabetes（OR=0.36,95%CI： 0.18,0.72）were risk factorsfor early rebleeding after EVL.Moderate grade of esophageal varices（OR=17.53,95%CI： 8.51,36.12）,Child-Pugh classification A（OR=4.24,95%CI：2.73,6.58）,Child-Pugh classification B（OR=3.86,95%CI： 2.55,5.85）,absence or presence of a small amount of ascites（OR=245.37,95%CI： 108.35,555.64）,small width of the portal vein（WMD=-2.45,95%CI：-3.92,-0.99）,few number of varices（WMD=-1.37,95%CI：-1.72,-1.01）,few number of ligated veins（WMD=-1.72,95%CI：-1.95,-1.50）,high level of hemoglobin（WMD=13.72,95%CI：2.35,25.09）,short prothrombin time（PT）（WMD=-3.54,95%CI：-4.84,-2.24）,low level of alanine aminotransferase（WMD=-6.48,95%CI：-11.59,-1.36）,low level of total bilirubin（WMD=-8.01,95%CI：-12.04,-3.98）,high level of prothrombin activity（WMD=11.03,95%CI： 6.09,15.96）,and few number of bands used（WMD=-1.49,95%CI：-1.64,-1.33）were protective factors for early rebleeding after EVL.Mild grade of esophageal varices had no significant correlation with early rebleeding after EVL.CONCLUSION： Improving Child-Pugh classification and blood coagulation function and decreasing the amount of ascites can reduce the risk for early rebleeding after EVL.
出处
《世界华人消化杂志》
CAS
北大核心
2013年第28期2987-2993,共7页
World Chinese Journal of Digestology
