乙型肝炎肝硬化食管胃底曲张静脉破裂出血患者合并急性心肌损伤危险因素分析

摘要

目的 分析乙型肝炎肝硬化食管胃底静脉曲张破裂出血患者合并急性心肌损伤的危险因素.方法 2010年7月~2015年12月我院收诊的乙型肝炎肝硬化食管胃底曲张静脉破裂出血患者152例,对他们的临床资料进行回顾性分析.按照不同临床资料进行分类,比较各因素下发生急性心肌损伤的差异,对有统计学差异的因素进行多因素Logistic回归分析,得出独立危险因素.结果 在152例乙型肝炎肝硬化食管胃底曲张静脉破裂出血患者中,有65例(42.8%)发生急性心肌损伤;单因素分析显示,年龄≤52岁的患者发生急性心肌损伤比例为34.7%,显著低于>52岁组患者的50.0%(P<0.05),体质指数(BMI)26 kg/m2的患者发生的比例为37.6%,显著低于>26 kg/m2患者的50.9%(P<0.05),肝功能Child A级患者的发生率低于B级和C级患者(27.6%对43.4%和52.5%,P<0.05),无高血压、无糖尿病、无心脏疾病史、血肌酐(sCr)<81μmol/L和C-反应蛋白(CRP)<16 mg/L的患者发生急性心肌损伤的比例分别为40.0%、39.8%、39.7%、34.3%和31.5%,分别显著低于相应有高血压患者(53.1%)、有糖尿病患者(55.2%)、有心脏疾病史者(61.9%)和血肌酐>81μmol/L患者(49.4%)和CRP>16 mg/L患者(53.2%,P<0.05),血钾>3.7 mmol/L的患者发生急性心肌损伤的比例为46.9%,显著高于血钾≤3.7 mmol/L患者的35.7%(P<0.05);多因素分析显示年龄、肝功能分级、糖尿病、心脏疾病史、sCr、血钾和CRP水平为影响患者发生急性心肌损伤的独立危险因素(P<0.05).结论 乙型肝炎肝硬化食管胃底静脉曲张破裂出血并发急性心肌损伤发生率高,危险因素多样,应注意防治.%Objective To analyze the risk factors for acute myocardial damage in patients with hepatitis B cirrhosis complicated by esophageal and gastric variceal bleeding. Methods Clinical data of 152 patients with hepatitis B cirrhosis and esophageal and gastric variceal bleeding between July 2010 and December 2015 were retrospectively analyzed. Acute myocardial damage were recorded. Independent risk factors were obtained by multivariate Logistic regression analysis. Results There were 65 patients (42.76%) having acute myocardial damage among the 152 patients with hepatitis B liver cirrhosis complicated by esophageal and gastric variceal bleeding;Univariate analysis showed that patients who were younger than 52 years,whose body mass index (BMI) less than 26 kg/m2,had liver function of Child-Pugh class A,had no hypertension,had no diabetes,had no history of heart disease,whose serum creatinine (sCr) levels being lower than 81 μmol/L and C-reactive protein (CRP) levels being lower than 16 mg/L,and blood potassium being lower than 3.7 mmol/L had lower incidence of acute myocardial damage as compared to those in the opposite ones (P<0.05 for all);the multivariate logistic regression analysis revealed that age,liver function class,diabetes mellitus,heart disease history,sCr level,serum potassium and CRP levels were the independent risk factors for acute myocardial damage in patients with hepatitis B cirrhosis and esophageal and gastric variceal bleeding. Conclusion The incidence of acute myocardial damage in patients with hepatitis B cirrhosis and esophageal and gastric variceal bleeding is high,which must be taken into consideration in clinical practice.