【作者】 张海云；

【导师】 吴扬；

【作者基本信息】 吉林大学 ， 临床医学， 2009， 硕士

【摘要】 肝硬化是终末期肝病的共同病理变化,上消化道出血是其常见致命的并发症,食管静脉曲张破裂出血是最常见的原因。由于胃镜检查许多患者难以接受,国内外学者对非侵入性检查预测食管静脉曲张的存在进行了大量研究,近几年对脾功能亢进相关指标的研究越来越多,但至今尚无统一预测标准,且较少学者将PC、SL、ST、SI、PC/SL、PC/ST、PC/SI 7项指标进行比较研究。针对此情况,本文对2005年1月至2009年1月间在我院消化科住院确诊为肝硬化的132例患者进行回顾性研究,探讨对食管静脉曲张的存在有预测价值的非侵入性检查指标,为临床预测食管静脉曲张存在及其破裂出血提供更准确的信息,指导临床医生及时采取预防措施。结果显示:1、肝硬化患者性别、年龄、病因构成比、CPG构成比在NEV与EV两组间无统计学差异(P>0.05)。2、性别、年龄、CPG、PV、SL、ST、PC/SL、PC/ST与肝硬化EV的发生无相关关系(P>0.05),而PC、SI、PC/SI对肝硬化EV的存在有预测价值(P<0.01)。PC与肝硬化EV的发生呈负相关(回归系数为-0.227,OR值为0.797),PC/SI与肝硬化EV的发生呈负相关(回归系数为-0.134,OR值为0.643),而SI与EV的发生呈正相关(回归系数为0.368,OR值为1.445)。更多还原

【Abstract】 Upper gastrointestinal bleeding is a common fatal complication of decompensated cirrhosis,and esophageal variceal bleeding is the most common cause. Even though gastroscopy can be the intuitive evaluation of the possibility of esophageal varices,it is subject to restrictions on patients and patients will be suffering.There is also the risk of inducing bleeding.Therefore, the use of non-invasive inspection conducted on the prediction of esophageal varices in cirrhosis seems particularly important.Domestic and foreign scholars have done a large number of studies on clinical parameters of liver and spleen ultrasound prediction target of esophageal varices, and mainly about hepatic portal vein and splenic vein diameter in the early stage.Many studies prove that there is a degree of consistency between the diameter of the portal vein, the degree of esophageal varices and the rate of esophageal variceal bleeding,but more often on clinical portal vein is not widened in patients with severe esophageal varices. Another scholars have done some research on the liver and spleen hemodynamics, left gastric vein and so on.In recent years more and more study have been done on hypersplenism related indicators such as platelet count, spleen length, spleen thickness,spleen index (spleen length×spleen thickness), the ratio between platelet count and the last three indicators.More and more studies abroad have proved that platelet count/spleen length can be predicted the existence of esophageal varices in hepatic cirrhosis, but most scholars abroad chose hepatitis C, alcoholic hepatic disease and primary biliary cirrhosis as the main study object, hepatitis B only took a very small percentage.So the repeatability of this indicator in cirrhosis of hepatitis B has not yet been confirmed.Some scholars proven that platelet count/spleen index can predict esophageal varices more accurately,but so far there is no uniform standard forecast.In this paper,we have made a comparative study on gender, age, liver function, portal vein, as well as hypersplenism related indicators to get some meaningful non-invasive indicators in the predicting of esophageal varices,and to guide the clinician to evaluate the possibility of esophageal varices.Then we can take measures to prevent the first bleeding as soon as possible to reduce mortality.Objective:In this study, We have made retrospective analysis on patients with hepatic cirrhosis and observed the relationship between their age, sex , cause of disease and esophageal varices.Our purpose is to explore the predictive value of PV, PC, SL, ST, SI, PC/SL, PC/ST, PC/SI and other indicators in hepatic cirrhosis with esophageal varices,to provide more accurate information for the prediction of clinical esophageal varices bleeding and to guide doctors to take timely preventive measures.Materials and Methods: Inclusion criteria:132 hospitalized patients of hepatic cirrhosis from January 2005 to January 2009 in our hospital. The diagnostic criteria of hepatic cirrhosis was in line with the inclusion criteria laid down by Institute of Chinese hepatic Medical Association. Among them, the number of male was 75, while female was 57. The youngest age was 25, the eldest age was 77, and mean age was 55.1±12.0. All of 132 cases will be divided into esophageal varices and non-esophageal varices by Gastroscopy results.In the overall samples, there were 60 cases in the group of NEV, and 72 cases in the group of EV.In the EV group,the mild EV was 20 cases, with moderate EV 18 cases and severe EV 34 cases. The diagnostic criteria of esophageal varices was in line with the grading standards laid down by Institute of Chinese Medical Association of Digestive Endoscopy Society in 2003. Liver function was classified into A, B, C 3 levels by Child-Pugh grading method,with A-grade 59 cases, B-grade 55 cases, and C-grade 18 cases.Exclusion criteria:(1) have the history of liver cancer, (2) have the history of gastrointestinal bleeding, (3) have the existence of other factors which can affect the platelet count and spleen size, (4) after splenectomy, (5) after liver surgery, (6) esophageal varicose vein surgery or sclerotherapy after ligation, (7) by the jugular intrahepatic portosystemic shunt after superior vena cava, (8) had used non-steroidal anti-inflammatory drugs, inhibit or promote bone marrow as well as the recent use of portal pressure lowering drugs, diuretics.We record the gender, age, cause of disease, PC, PV, SL, ST, SI, CPG of all patients.To observe:1, whether sex, age between NEV and EV groups of hepatic cirrhosis have differences? 2, The constitute of cause in NEV and EV groups of hepatic cirrhosis. Whether constituent ratio of cause between NEV and EV groups in cirrhosis have differences? 3, The constituent ratio of Child-Pugh grading in NEV and EV groups of hepatic cirrhosis and the relationship between Child-Pugh grading and the presence or absence of esophageal varices.4, Select the indicators which can be used to predict the existence of esophageal varices in hepatic cirrhosis from the following 11 indicators: PV, PC, SL, ST, SI, PC / SL, PC / ST, PC / SI, sex, age, CPG..Results:1、Among the 132 cases of hepatic cirrhosis, there were 60 (45.45%) cases in the group of NEV, the number of male was 32,while female was 28, the ratio of male to female was 1:0.88, and mean age was 55.0±12.7;there were 72 (54.55%) cases in the group of EV, the number of male was 43,while female was 29, the ratio of male to female was 1:0.67, and mean age was 55.1±11.5;There are no statistical difference on patient sex and age between the two groups of NEV and EV.2、The cause composition of the 132 cases of hepatic cirrhosis was as follows: posthepatic alcoholic cirrhosis 5 cases (3.8%), posthepatic cirrhosis of chronic hepatitis B 75cases (56.8%), posthepatic cirrhosis of chronic hepatitis C 18 cases (13.6%), posthepatic cirrhosis of chronic hepatitis B combined alcoholic liver disease 9 cases (6.8%), posthepatic cirrhosis of chronic hepatitis C combined alcoholic liver disease 3 cases (2.3%), posthepatic cirrhosis of chronic hepatitis B and C infection 8 cases (6.1%), cryptogenic cirrhosis 14 cases (10.6%). There are no statistical difference on patient cause composition between the two groups of NEV and EV.3、The constituent ratio of Child-Pugh grading A, B, C in two groups: class A accounts 60.0% (36/60), class B accounts 33.3% (20/60), class C accounts 6.7% (4/60) in NEV group;the counterparts in EV group are40.3% (29/72), 48.6% (35/72), 11.1% (8/72). There are no statistical difference on the constituent ratio of Child-Pugh grading between the two groups of NEV and EV in the 132 cases of hepatic cirrhosis patients.4、There is negative correlation between platelet count and esophageal varices in liver cirrhosis (regression coefficient =-0.227, OR=0.797), negative correlation between PC platelet count/spleen index and esophageal varices in liver cirrhosis (regression coefficient -0.134, OR =0.643), but positive correlation between spleen index and esophageal varices in liver cirrhosis (regression coefficient 0.368, OR=1.445). There is no correlation between other index and the occurrence of esophageal varices in liver cirrhosis.Conclusions:1、There are no significant relationship between sex, age and the occurrence of esophageal varices in patients with hepatic cirrhosis.2、There are no significant relationship between hepatic function Child-Pugh classification and the occurrence of esophageal varices in patients with hepatic cirrhosis3、PC, SI, PC / SI have predictive meaning in the occurrence of esophageal varices in hepatic cirrhosis, but sex, age, hepatic function,PV, SL, ST, PC / SL, PC / ST don,t have.4、There is negative correlation between platelet count ,platelet count/spleen index and esophageal varices in hepatic cirrhosis, but positive correlation between spleen index and esophageal varices in hepatic cirrhosis.Platelet count, platelet count / spleen index are protective factors of esophageal varices in hepatic cirrhosis, but the spleen index is the risk factor of esophageal varices in hepatic cirrhosis.Increased spleen index, decreased platelet count and platelet count / spleen index all have predictive valueon the existence of esophageal varices in hepatic cirrhosis.更多还原