111例胃Dieulafoy病出血临床特征及再出血危险因素分析

摘要： 目的??Dieulafoy病是一种较少见的上消化道出血性疾病，该研究目的是认识胃Dieulafoy病临床特点及Dieulafoy病经治疗后再次出血的风险因素。方法?回顾性研究2009年1月－2016年6月于南昌大学第一附属医院消化内镜中心经胃镜确诊为胃Dieulafoy病出血患者，分析患者的临床资料、内镜下特点及再出血危险因素。结果?在111例患者中，男97例（87.4%）；发病部位主要好发于胃底及高位胃体53例（47.7%），按Forrest分级主要为Ⅰ期52例（46.8%）及Ⅱ期58例（52.3%）；主要以内镜联合药物治疗为主101例（91.0%），内镜治疗方法止血成功率为84.2%，单种内镜、两种内镜、三种内镜治疗方法的止血率分别为85.0%、84.8%、75.0%。对于101例行内镜联合药物治疗患者，胃底及高位胃体、中低位胃体、胃窦的止血成功率分别为83.7%、82.1%、88.9%。在111例上述观察指标中，年龄（P =0.002）和输血（P =0.004）在单因素分析中是再出血危险因素；在101例均已行内镜处理的Dieulafoy病出血的患者中，Logistic回归多因素分析，表明输血（P =0.018，OR=37.77，95%CI=1.86～766.47）为经治疗后再出血独立的危险因素。结论?内镜治疗是一种有效的治疗方法，输血为经治疗后再出血独立的危险因素，各种内镜治疗方法无明显差异，出血部位不同在经治疗后再出血组与非再出血组间无明显差异。
Abstract: Objective?Dieulafoy’s lesion is a rare cause of upper gastrointestinal bleeding. The purpose of this study was to recognize the clinical characteristics of gastric Dieulafoy and to identify possible predictive factors of rebleeding.?Methods?Retrospective study of patients with gastrointestinal bleeding secondary to Dieulafoy’s lesion from January 2009 to June 2016. We analyzed the clinical data and endoscopic findings and the correlated with rebleeding risk factors with Dieulafoy’s lesion.?Results?111 patients were included in the study, 97 (87.4%) patients were male; the most common location of the bleeding lesions were Proximal stomach of 53 cases (47.7%); According to the Forrest type, 46.8% of the cases were arterial (spurting), 52.3% of the cases were arterial (oozing), there were 101 (91.0%) patients treated by endoscopic combined drug therapy. The success rate of Endoscopic hemostatic treatment was 84.2%, endoscopic hemostatic treatment success rate was as follows: single endoscopic, 85.0%; two endoscopic, 84.8%; three endoscopic, 75.0%. The hemostatic treatment success rate of 101 patients with endoscopic combined drug was as follows: Proximal stomach, 83.7%; mid-stomach, 82.1%; and distal stomach, 88.9%. Age (P = 0.002) and blood transfusion (P = 0.004) were risk factors for rebleeding in the study. Blood transfusion was associated with a higher recurrence rate for bleeding (P = 0.018, OR =37.77, 95% CI = 1.86~766.47) for 101 patients with endoscopic in combination with drug.?Conclusion?Endoscopic therapy is effective for treating Dieulafoy’s lesion. The blood transfusion was associated with a high rate of bleeding recurrence. There were no significant differences between the rebleeding and non-rebleeding groups with respect to bleeding location or hemostatic methods.