血管紧张素Ⅱ联合PGA指数对酒精性肝病、食管胃底静脉曲张及出血的预测意义  

The predictive significance of angiotensin Ⅱ combined with PGA index for esophagogastric varices and bleeding in alcoholic liver disease

作　　者：徐艳丽 邓敏 吴一鸣 XU Yanli;DENG Min;WU Yiming(Department of Infection,Jiaxing City the First Hospital in Zhejiang Province,Jiaxing314000,China;Institute of Hepatology,Jiaxing City the First Hospital in Zhejiang Province,Jiaxing314000,China)

机构地区：[1]浙江省嘉兴市第一医院感染科,浙江嘉兴314000 [2]浙江省嘉兴市第一医院嘉兴市肝病研究所,浙江嘉兴314000

出　　处：《中国现代医生》2020年第16期28-31,F0003,共5页China Modern Doctor

基　　金：浙江省科技计划项目(2017C33202);浙江省嘉兴市科技计划项目(2018AD32067)。

摘　　要：目的探讨血管紧张素Ⅱ(AngⅡ)联合PGA指数无创性评估酒精性肝病患者食管胃底静脉曲张程度及出血风险。方法选取2017年6月~2018年6月嘉兴市第一医院收治的82例酒精性肝病患者,用胃镜检查评估食管胃底静脉曲张的程度,并测定血AngⅡ水平,计算PGA指数。比较不同食管胃底静脉曲张程度患者的AngⅡ水平和PGA指数。随访6个月,对AngⅡ和PGA指数预测出血的诊断效能进行比较。结果胃镜下食管胃底静脉曲张0级组、1级组、2级组、3级组的AngⅡ分别为(2318.621±346.043)pg/mL、(2867.420±383.144)pg/mL、(3430.193±686.725)pg/mL、(4204.723±997.436)pg/mL,PGA指数分别为(2.858±0.210)、(3.848±0.265)、(5.446±0.585)、(7.944±0.891)。AngⅡ和PGA指数均与食管胃底静脉曲张的严重程度相关,AngⅡ的相关系数为0.701,P=0.001;PGA指数的相关系数为0.774,P=0.013。随访6个月出血组的AngⅡ为(3705.471±784.323)pg/mL,PGA指数为(6.591±2.094);未出血组的AngⅡ为(3185.862±914.118)pg/mL,PGA指数为(4.851±2.234)。出血组AngⅡ(敏感度0.765,特异度0.646)和PGA指数(敏感度0.882,特异度0.523)均明显高于未出血组,差异有统计学意义(P<0.05)。结论AngⅡ联合PGA指数能良好预测酒精性肝病患者食管胃底静脉曲张程度及出血风险,为临床医生及时判断病情、采取进一步措施提供指导意见。Objective To explore the noninvasive evaluation of angiotensin Ⅱ(Ang Ⅱ)combined with PGA index for the degree of esophagogastric varices and the risk of bleeding in patients with alcoholic liver disease.Methods A total of 82 patients with alcoholic liver disease admitted to Tiaxing City First Hospital from June 2017 to June 2018 were selected for gastroscopy to evaluate the degree of esophagogastric varices.The blood Ang Ⅱ level was determined,and the PGA index was calculated.The Ang Ⅱ level and PGA index of patients with different esophagogastric varices were compared.The patients were followed up to 6 months.The diagnostic efficacy of Ang Ⅱ and PGA index in predicting bleeding was compared.Results The Ang Ⅱ of gastroscopic esophagogastric varices degree 0 group,degree 1 group,degree 2 group and degree 3 group were(2318.621±346.043)pg/mL,(2876.420±383.144)pg/mL,(3340.193±686.725)pg/mL,and(4204.723±997.436)pg/mL,and the PGA indexes were(2.858±0.210),(3.848±0.265),(5.446±0.585),and(7.944±0.891)respectively.Both Ang Ⅱ and PGA index were related to the severity of esophagogastric varices.The correlation coefficient of Ang Ⅱ was 0.701,P=0.001.The correlation coefficient of PGA index was 0.774,P=0.013.After 6 months of follow-up,the Ang Ⅱ and the PGA index was(3705.471±784.323)pg/mL and(6.591±2.094)in the bleeding group.The Ang Ⅱ of the non-bleeding group was(3185.862±914.118)pg/mL,and the PGA index was(4.851±2.234).The Ang Ⅱ(sensitivity 0.765,specificity 0.646)and PGA(sensitivity 0.882,specificity 0.523)indexes in the bleeding group were significantly higher than those in the non-bleeding group,and the difference was statistically significant(P<0.05).Conclusion Ang Ⅱ combined with PGA index can well predict the degree of esophagogastric varices and bleeding risk in patients with alcoholic liver disease.It can provide guidance advice for clinical doctors to timely judge the condition and take further measure.

关 键 词：血管紧张素Ⅱ PGA指数 酒精性肝病 食管胃底静脉曲张 出血 

分 类 号：R575.5[医药卫生—消化系统]