特发性非肝硬化性门静脉高压症的临床及病理特点分析  

Analysis of clinical and pathological features of idiopathic non-cirrhotic portal hypertension

作　　者：王晴晴 彭宇辉 唐艳芳[3] WANG Qing-qing;PENG Yu-hui;TANG Yan-fang(Department of Hepatopathy,Kunming Third Municipal People's Hospital,Yunnan 650041,China;Second Livrr Failure Center,the Fifth Medical Center of PLA General Hospital,Beijing 100039,China;Department of Hepatopathy,Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine Nanning 530011,China)

机构地区：[1]昆明市第三人民医院肝病科,云南650041 [2]解放军总医院第五医学中心肝衰竭二中心 [3]广西中医药大学附属瑞康医院肝病科

出　　处：《肝脏》2021年第3期291-295,共5页Chinese Hepatology

摘　　要：目的探讨特发性非肝硬化性门静脉高压症(INCPH)的临床及病理特点。方法回顾性分析44例患者的临床资料,其中23例为INCPH,21例为病毒性肝炎失代偿期肝硬化,比较二者之间的差异,同时分析23例INCPH患者的病理特点。结果 INCPH组以女性(60.87%)为主,年龄较轻(39.8±15.4)岁,而病毒性肝炎失代偿期肝硬化组以男性(80.95%)为主,年龄较大(53.3±11.2)岁,差异均有统计学意义(P<0.05)。INCPH组以消化道出血(39.13%,9/23)为主要就诊症状,而病毒性肝炎失代偿期肝硬化组以腹水(85.71%,18/21)为主要就诊症状。与INCPH组相比,病毒性肝炎失代偿期肝硬化组红细胞(RBC)、血小板(PLT)、凝血酶原活动度(PT)、白蛋白(Alb)、胆碱酯酶(CEA)明显降低[RBC:(3.79~4.14)×10^(12)/L比(3.33~3.94)×10^(12)/L,PLT:(91~235)×10^(9)/L比(41~72)×10^(9)/L,PT:(66.5~95)%比(49.60~65.00)%,Alb:(37~39)g/L比(26~33)g/L,CEA:(4596~6408)U/L比(2368~3497.5)U/L,均P<0.05];而凝血国际标准化比值(INR)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、总胆红素(TBil)、肝脏硬度值(LSM)、肝功能评分(CTP)明显高于INCPH组[INR:(1.02~1.19)比(1.19~1.42),ALT:(15~21)U/L比(17.50~36.50)U/L,AST:(21~31)U/L比(32~57)U/L,TBil:(10.8~18.3)μmol/L比(20.05~43.05)μmol/L,LSM:(5.90~13.3)kPa比(17.60~24.85)kPa,CTP:(5~7)比(7~9),均P<0.05],但白细胞(WBC)、血红蛋白(HGB)两组比较无差异(P>0.05)。同时两组比较,INCPH组有明显脾脏增厚、门静脉结构紊乱、门静脉海绵样变性、侧支循环建立,差异均有统计学意义[脾厚:(51~79)mm比(49~59)mm,门静脉结构紊乱:34.78%比4.76%,门静脉海绵样变性:39.13%比4.76%,侧支循环建立:65.22%比33.33%,P<0.05],但门静脉直径、脾静脉直径、脾静脉直径/门静脉直径、脾大发生率、门脉高压性胃病发生率以及食管和胃底静脉曲张程度均无差异(P>0.05)。23例INCPH患者的肝组织病理主要表现为肝细胞排列基本正常、无假小叶形成、门静脉Objective To compare the clinical parameters between idiopathic non-cirrhotic portal hypertension(INCPH)and virus hepatitis-related decompensated cirrhosis,and to analyze clinical and pathological features of INCPH.Methods Clinical data of 44 patients,including 23 patients with INCPH and 21 with virus hepatitis-related decompensated cirrhosis,were retrospectively analyzed.The clinical parameters were compared between the 2 groups,and the pathological characteristics of INCPH were investigated.Results The patients in INCPH group were younger(39.83 ± 15.38 years)and predominantly female(60.87%),while the patients in decompensated cirrhosis group were older(53.33 ± 11.24 years)and predominantly male(80.95%),and the differences were statistically significant(P<0.05).The main symptom was gastrointestinal bleeding(39.13%)in INCPH group,and ascites(85.71%)in the other group(P<0.05).Red blood cell,platelet,prothrombin activity,albumin,cholinesterase in virus hepatitis-related decompensated cirrhosis group were significantly lower than those in INCPH group(P<0.05),while international normalized ratio,alanine transaminase,aspartate transaminase,total bilirubin,liver stiffness measurement and Child-Turcotte-Pugh score were significantly higher than those in INCPH group(P<0.05).And there was no significant difference in white blood cell or hemoglobin between the 2 groups(P>0.05).Compared with virus hepatitis-related decompensated cirrhosis group,INCPH group had thicker spleen,more portal vein structure disorder,more portal vein cavernous degeneration,and more collateral circulation,and the differences were statistically significant(P<0.05).However,there were no significant differences in portal vein diameter,splenic vein diameter,splenic vein diameter/portal vein diameter,incidence of splenomegaly,incidence of portal hypertensive gastropathy or degree of esophageal and gastric varices between the 2 groups(P >0.05).The liver histopathology of INCPH mainly showed that there was no obvious disorder of hepatocyte arrangement,f

关 键 词：特发性非肝硬化性门静脉高压症 病毒性肝炎 失代偿期肝硬化 病理 

分 类 号：R575.2[医药卫生—消化系统]