【摘要】：背景:肝硬化是慢性肝病患者的終末期改變,肝硬化最顯著的特征是門(mén)靜脈高壓,而側(cè)支循環(huán)形成是門(mén)脈高壓的主要特點(diǎn)之一,其中臍靜脈開(kāi)放是側(cè)支循環(huán)開(kāi)放中比較常見(jiàn)的一種類型,但臍靜脈開(kāi)放對(duì)肝硬化患者的臨床意義尚不清楚。目的:研究肝硬化患者合并臍靜脈開(kāi)放的臨床特點(diǎn),探討其與肝功能受損情況、肝性腦病、腹水、門(mén)靜脈血栓、食管胃底靜脈曲張、以及消化道出血的關(guān)系,探討臍靜脈開(kāi)放的臨床意義。材料與方法:收集2012.01-2015.10期間就診于南昌大學(xué)第二附屬醫(yī)院消化內(nèi)科的肝硬化患者,以CT結(jié)合其他臨床指標(biāo)進(jìn)行診斷。通過(guò)CT判斷是否存在臍靜脈開(kāi)放,隨機(jī)抽取部分臍靜脈未開(kāi)放患者作為對(duì)照。收集這些患者一般情況、病史特點(diǎn)、血清生化指標(biāo)、電子胃鏡、腹部彩超及腹部CT等資料,然后使用SPSS17.0軟件進(jìn)行統(tǒng)計(jì)分析。結(jié)果:共確診247例肝硬化患者,其中有臍靜脈開(kāi)放50例,臍靜脈開(kāi)放率為20.2%。臍靜脈開(kāi)放和未開(kāi)放兩組對(duì)比白蛋白、膽紅素、INR、肌酐的95%CI分別為-2.48~0.54(P1=0.206),-31.6~4.34(P2=0.99),-0.15~0.15(P3=0.457),-22.0~10.0(P4=0.134),臍靜脈開(kāi)放對(duì)這些值沒(méi)有影響。Child-Pugh分級(jí)為A級(jí)占8.7%,B級(jí)占42%,C級(jí)占49.3%(P0.05),兩組的MELD評(píng)分R值分別是7.94±5.87、6.67±4.69(P0.05),臍靜脈開(kāi)放可以降低Child-Pugh分級(jí),但不能改變MELD評(píng)分。臍靜脈開(kāi)放組患者肝性腦病的發(fā)生率有20%,而臍靜脈未開(kāi)放組肝性腦病發(fā)生率有14%,臍靜脈開(kāi)放會(huì)增加肝性腦病的發(fā)生(P0.05)。臍靜脈開(kāi)放不能減少腹水形成(P0.05)。臍靜脈開(kāi)放組無(wú)食管胃底靜脈曲張占10%,重度曲張占48%,臍靜脈未開(kāi)放組無(wú)食管胃底靜脈曲張占11%,重度曲張占54%(P0.05);臍靜脈開(kāi)放組消化道出血率占32%(16/50),臍靜脈未開(kāi)放組占39%(39/100)(P0.05),臍靜脈開(kāi)放不能降低食管胃底靜脈的形成和出血。臍靜脈開(kāi)放組患者門(mén)靜脈血栓形成率為8%,臍靜脈未開(kāi)放組為12%(P0.05);門(mén)靜脈海綿樣變性臍靜脈開(kāi)放組0例,臍靜脈未開(kāi)放組有8例(P0.05),臍靜脈開(kāi)放不能減少門(mén)靜脈血栓形成,但無(wú)門(mén)靜脈海綿樣變性發(fā)生。結(jié)論:臍靜脈開(kāi)放不能減少出血和腹水,對(duì)門(mén)靜脈血栓形成無(wú)影響。臍靜脈開(kāi)放可能降低Child-Pugh分級(jí),但對(duì)MELD評(píng)分無(wú)影響,臍靜脈開(kāi)放后會(huì)增加肝性腦病的發(fā)生率。因此,臍靜脈開(kāi)放對(duì)肝硬化無(wú)積極的作用,可能是疾病進(jìn)展的標(biāo)志。
[Abstract]:Background: cirrhosis is an end-stage change in patients with chronic liver disease. Portal hypertension is the most prominent feature of cirrhosis, and collateral circulation is one of the main characteristics of portal hypertension. Umbilical vein opening is a common type of collateral circulation, but the clinical significance of umbilical vein opening in patients with liver cirrhosis is not clear. Objective: to study the clinical features of cirrhotic patients complicated with umbilical vein opening and its relationship with hepatic dysfunction, hepatic encephalopathy, ascites, portal vein thrombosis, esophageal and gastric varices, and gastrointestinal bleeding. To explore the clinical significance of umbilical vein opening. Materials and methods: patients with liver cirrhosis who were admitted to the Department of Gastroenterology, second affiliated Hospital of Nanchang University during the period of 2012.01-2015.10 were diagnosed by CT combined with other clinical indexes. CT was used to determine whether umbilical vein was open or not. The data of general condition, history, serum biochemical index, electronic gastroscope, abdominal color ultrasound and abdominal CT were collected and analyzed by SPSS17.0 software. Results: a total of 247 patients with liver cirrhosis were diagnosed, including 50 cases of umbilical vein opening, the rate of umbilical vein opening was 20.2um. The 95%CI of albumin, bilirubin and INR, creatinine were -2.48 ~ 0.54 (P _ 1: 0.206), -31.6N _ 4.34 (P _ 2N _ (0.99), -0.15C _ (0.15) (P _ (3) P _ (0.457), respectively. -22.0n 10.0 (P40.134), umbilical vein opening had no effect on these values. Child-Pugh grade A accounted for 8.7% and B grade 49.3% (P 0.05). The MELD score R value of the two groups was 7.94 鹵5.87 鹵6.67 鹵4.69 (P0.05). Umbilical vein opening could decrease the Child-Pugh grade, but could not change the MELD score. The incidence of hepatic encephalopathy in the open umbilical vein group was 20 and that in the non-open umbilical vein group was 14. The opening of the umbilical vein would increase the incidence of hepatic encephalopathy (P0.05). Umbilical vein opening could not reduce ascites formation (P0.05). In the open umbilical vein group, 10 cases were without esophageal and gastric fundus varices, 48 were severe varices, 11 were esophageal and gastric fundus varices, and 54% were severe varices (P0.05). The gastrointestinal bleeding rate was 32% (16 / 50) in the open umbilical vein group and 39% (39 / 100) in the non-open umbilical vein group (P0.05). The portal vein thrombosis rate was 8% in the open umbilical vein group and 12% in the non-open umbilical vein group (P0.05). There were 0 cases in cavernous portal vein open group and 8 cases in non-open umbilical vein group (P0.05). Umbilical vein opening could not reduce portal vein thrombosis, but there was no portal cavernous degeneration. Conclusion: umbilical vein opening can not reduce bleeding and ascites, and has no effect on portal vein thrombosis. Umbilical vein opening may decrease Child-Pugh grade, but has no effect on MELD score, and increases the incidence of hepatic encephalopathy after umbilical vein opening. Therefore, umbilical vein opening has no positive effect on cirrhosis and may be a marker of disease progression.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R575.2

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本文編號(hào)：2375070