慢性肝病与小肠黏膜炎症的相关性研究  

The correlation between chronic hepatic diseases and small intestinal inflammation

作　　者：吴礼浩[1] 陈美慧[1] 蔡洁毅[1] 袁瑜[1] 何兴祥[1] 

机构地区：[1]广东药科大学附属第一医院消化内科,广州510080

出　　处：《中华消化内镜杂志》2017年第5期322-325,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨慢性肝病是否会发生小肠黏膜炎症，以及二者的相关性。方法回顾性收录广东药科大学附属第一医院2011年8月至2015年8月期间行胶囊内镜检查的患者资料，根据临床资料分为肝硬化组、非酒精性脂肪肝组、慢性肝炎组及无肝病组，利用小肠黏膜炎症Lewis评分系统对所有患者进行小肠黏膜病变严重程度评分，比较各组小肠黏膜病变发病率及Lewis评分情况。将所有患者进行无创肝功能评分，分析慢性肝病肝功能损害与小肠黏膜病变的相关性。结果共纳入338例患者，其中肝硬化组25例，非酒精性脂肪肝组47例，慢性肝炎组20例，无肝病组246例。4组患者中有小肠黏膜病变者分别为22例（88．0％）、36例（76．6％）、12例（60．O％）、78例（31．7％），差异有统计学意义（P〈O．001）。其中肝硬化组、非酒精性脂肪肝组、慢性肝炎组绒毛水肿发生率显著高于无肝病组（P值均〈0．017）。小肠黏膜绒毛水肿主要发生在上、中1／3肠段（P=0．033）。肝硬化组、非酒精性脂肪肝组小肠黏膜炎症Lewis评分（190．80±228．42和125．38±191．31）显著高于无肝病组的42．91±97．69（P=0．021，P=0．034）。Forns纤维化指数、FIB-4评分、NAFLD—FS评分及Child—Pu外评分均与小肠黏膜Lewis评分呈正相关，相关系数分别为0．247、0．244、0．223、0．284，P值均〈0．001。结论肝硬化、非酒精性脂肪肝和慢性肝炎可能是发生小肠黏膜炎症的危险因素，慢性肝病严重程度与小肠黏膜病变程度呈正相关。Objective To investigate the correlation between chronic hepatic diseases and small intestinal inflammation. Methods Patients who received capsule endoscopy in The First Affiliated Hospital of Guangdong Pharmaceutical University were divided into groups of liver cirrhosis, non-alcoholic fatty liver disease（NAFLD）, chronic hepatitis and non-hepatic disease according to clinic data fi＇om August 2011 to August 2015. The severity of small intestinal mucosal inflammation was graded according to Lewis Scoring system and incidence of small intestinal lesions in different groups and Lewis scores were compared.The liver function was also graded with liver noninvasive scoring systems. Then the correlation between liver function damage and small intestinal lesions was investigated. Results A total of 338 cases were enrolled in the study, including 25 cases of liver cirrhosis, 47 cases of NAFLD, 20 cases of chronic hepaitis and 246 cases of non-hepatic disease. There were 22 （ 88.0% ） , 36 （ 76. 6% ） , 12 （ 60. 0%） and 78 （ 31.7%） cases with lesions in small intestine in the four group respectively with significant differences（ P〈0. 001 ）. Rate of small intestinal villi edema was significantly higher in liver cirrhosis group, NAFLD group, chronic hepatitis group than that in non-hepatic disease group（ all P〈0. 017）. Small intestinal villi edema was found mainly in the upper and one third of middle parts in small intestine （ P = 0. 033）. Lewis scores of liver cirrhosis group （ 190. 80±228.42） and NAFLD group（ 125.38±191.31 ） were higher than those of non-hepatic disease group （42. 91±97.69,P = 0. 021, P = 0. 034）. Forns score, FIB-4 score, NAFLD-FS score and Child-Pugh scorewere positively correlated with Lewis score （correlation coefficient： 0. 247, 0.244, 0.223, 0.284 respectively, all P〈0. 001 ）. Conclusion Chronic hepatic diseases such as liver cirrhosis, NAFLD, chronic hepatitis might be risk factors for small intestinal mucosal inflammation, and the severity o

关 键 词：肝硬化 脂肪肝 慢性肝炎 小肠黏膜病变 

分 类 号：R574.5[医药卫生—消化系统] R575[医药卫生—内科学]