老年肝硬化食管胃静脉曲张患者内镜治疗预后影响因素分析

Influence Factors on the Prognosis of the Elderly with Cirrhotic Gastroesophageal Varices after Endoscopic Treatment

中文关键词: 食管胃静脉曲张  内镜治疗  二级预防  老年

英文关键词: gastroesophageal varices  endoscopic treatment  secondary prevention  the elderly

中文摘要:

      目的 观察经内镜治疗预防肝硬化食管胃静脉曲张再出血的老年患者远期生存及再出血情况,并分析影响预后的因素.方法 通过回顾性队列研究,纳入2008年1月1日-2015年1月31日间至复旦大学附属中山医院消化科就诊的食管胃静脉曲张老年患者,通过回顾病史及电话随访,获取患者资料及预后情况,通过绘制生存曲线及Cox回归来分析患者预后及影响因素.结果 共纳入患者181例,60 ～ 85岁,中位年龄65岁,随访期间死亡43例,中位生存时间(62±3.55)月(95％可信区间(CI) 55.04～68.96);发生再出血56例,中位未再出血时间(61 ±6.14)月(95％CI48.97 ～ 73.03).通过单因素及多因素分析,影响老年患者远期生存的独立预测因子为静脉曲张类型(GOV+ IGV Vs EV,HR=2.382,95 ％CI 1.201～4.725)和内镜治疗次数(HR=0.585,95％CI0.445～0.771).结论 以上肝硬化食管胃静脉曲张患者中,年龄及Child分级不影响远期生存;内镜治疗后单纯食管静脉曲张型患者远期生存率较高,但合并胃静脉曲张的患者同样可以通过积极进行内镜治疗来改善预后.

英文摘要:

      Objective To observe the long-term survival and re-bleeding rate in the elderly with cirrhotic gastroes ophageal varices after endoscopic treatment.Methods Elderly patients with gastroesophageal varices in Department of Gastroenterology,Zhongshan Hospital,Fudan University during the period from Jan.,2008 to Jan.,2015 were enrolled in the retrospective cohort study.The data and prognosis of the patients were obtained through case history review and phone-call follow-up;Kaplan-Meier curve and Cox regression analysis were made in analyzing the influencing factors.Results 181 patients were enrolled in total.The median age was 65 years,from 60 to 85 years old,and the median length of follow-up was 30 months,from 1 to 89 months.43 deaths occurred in the follow-up period with a median survival time of 62±3,55 months (95 ％ CI55.04-68.96) and 56 re-bleeding,the median rebleeding-free time was 61 ± 6.14 months (95 ％ CI48.97-73.03).Univariate and multivariate analysis indicated that type of varices (GOV+IGV vs EV,HR=2.382,95％CI 1.201-4.725) and the time number of endoscopic treatment (HR=0.585,95％CI 0.445-0.771) were the independent predictors of longterm survival in elderly patients.Conclusions Age and Child-Pugh grade are of no impact on the long-term survival of patients with gastroesophageal varices aged over 60.The long-term survival rate in patients with esophageal varices only is higher after endoscopic treatment while positive endoscopic treatments can also improve the prognosis of the patients with esophageal varices complicated with gastric varices.