基于门静脉压力梯度等多因素的肝硬化门静脉高压食管静脉曲张破裂出血风险评估初步探讨  

Preliminary study on the risk evaluation of the rupture and hemorrhage of esophageal varices due to cirrhotic portal hypertension based on portal pressure gradient

作　　者：孙世蒙 牟玉珍 于海东[1] 李玉彪 马存凯[1] 雷振武[1] SUN Shimeng;MU Yuzhen;YU Haidong;LI Yubiao;MA Cunkai;LEI Zhenwu(Department of Interventional Radiology,Affiliated Hospital of Qinghai University,Xining,Qinghai Province 810001,China)

机构地区：[1]青海大学附属医院介入科,西宁810001

出　　处：《介入放射学杂志》2020年第8期807-810,共4页Journal of Interventional Radiology

基　　金：青海省卫生健康委重点课题项目(2018.wjzd-13);青海大学中青年科研基金(2018-QYY-12)。

摘　　要：目的探讨门静脉压力梯度(PPG)、食管静脉曲张程度、胃冠状静脉直径、门静脉直径及肝纤维化指标等在肝硬化门静脉高压食管静脉曲张破裂出血患者风险评估中的作用。方法收集2017年1月至2019年3月青海大学附属医院明确诊断为肝硬化门静脉高压食管静脉曲张拟行颈静脉肝内门体分流术(TIPS)患者106例,分为出血组与未出血组,统计所有患者术前PPG、影像学资料、实验室检验、胃镜检查、核医学肝纤维化指标、门静脉造影等资料。结果出血组、未出血组患者伴腹水、肝功能ChildPugh分级、胃冠状静脉直径、食管静脉曲张程度、门静脉直径、PPG指标比较,差异均有统计学意义(P<0.05)。出血组患者透明质酸钠(HA)、Ⅲ型前胶原氨基端肽(PⅢNP)、Ⅳ型胶原(ⅣC)均高于未出血组,差异有统计学意义(P<0.05),层粘连蛋白(LN)差异无统计学意义(P>0.05)。与单因素评分相比,门静脉高压食管静脉曲张破裂出血多因素评分预测食管静脉曲张破裂出血的灵敏度、特异度更高。结论以PPG为核心的多因素评分评估肝硬化食管静脉曲张破裂出血,较单一因素评估具有更好的灵敏度和特异度。对曲张静脉高危患者中HA、PⅢNP、ⅣC明显增高患者进行早期干预,可能降低破裂出血风险。Objective To explore the role of portal pressure gradient(PPG),degree of esophageal varices,diameter of gastric coronary vein,portal vein diameter and hepatic fibrosis index in evaluating the risk of esophageal varices rupture in patients with cirrhotic portal hypertension.Methods A total of 106 patients with confirmed esophageal varices due to cirrhotic portal hypertension,who were admitted the the Affiliated Hospital of Qinghai University of China during the period from January 2017 to March 2019 and scheduled to receive TIPS,were enrolled in this study.The patients were divided into hemorrhage group and non-hemorrhage group.The preoperative PPG,imaging data,laboratory testing,gastroscopy,nuclear medicine indexes of liver fibrosis,portal venography,etc.were collected and analyzed.Results There were statistically significant differences in ascites,Child-Pugh grade of liver function,gastric coronary vein diameter,degree of esophageal varices,portal vein diameter and PPG between the hemorrhage group and the non-hemorrhage group(P<0.05).The levels of sodium hyaluronic acid(HA),typeⅢprocollagen aminopeptide(PⅢNP)and typeⅣcollagen(ⅣC)in the hemorrhage group were strikingly higher than those in the non-hemorrhage group,the differences between the two groups were statistically significant(P<0.05).No statistically significant difference in the level of laminin(LN)existed between the two groups(P>0.05).For predicting esophageal varices rupture bleeding due to cirrhotic portal hypertension,the sensitivity and specificity of multivariate assessment scores were higher than those of univariate assessment scores.Conclusion For the evaluation of esophageal variceal bleeding risk in patients with cirrhotic portal hypertension,the multivariate assessment score based mainly on PPG is superior to single factor assessment score in the sensitivity and specificity for predicting the risk of esophageal varices rupture bleeding.For high-risk patients with varicose veins who have significantly high levels of HA,PⅢNP andⅣc,ea

关 键 词：门静脉压力梯度 门静脉高压症 食管静脉曲张 肝纤维化 

分 类 号：R541.4[医药卫生—心血管疾病] R657[医药卫生—内科学]