非肝硬化门脉高压患者临床特点分析  

Clinical features and hepatic venous pressure gradientchanges in patients with noncirrhotic portal hypertension

作　　者：周慧 冯晓宁 任浩[1] 刘杜先 杨永峰 熊清芳 Zhou Hui;Feng Xiaoning;Ren Hao(Department of Liver Diseases,Second Hospital,Affiliated to Nanjing University of Traditional Chinese Medicine,Nanjing 210003,Jiangsu Province,China)

机构地区：[1]南京中医药大学附属南京市第二医院肝病科,南京市210003

出　　处：《实用肝脏病杂志》2021年第3期415-418,共4页Journal of Practical Hepatology

基　　金：国家自然科学基金资助项目(编号:81970454);江苏省消化系统炎性疾病新药临床评价技术平台建设基金资助项目(编号:2018ZX09201016)。

摘　　要：目的总结非肝硬化门脉高压症(NCPH)患者的临床特点和肝静脉压力梯度(HVPG)的变化。方法2017年1月~2019年12月南京市第二医院住院的28例NCPH患者,采用Seldinger法穿刺右侧颈内静脉,使用一次性球囊导管测定肝静脉压力,计算HVPG,接受肝活检检查。结果在本组28例NCPH患者中,诊断特发性门脉高压(IPH)11例,非特发性门脉高压(NIPH)17例;IPH组平均年龄为(40.6±15.8)岁,显著小于NIPH组【(53.0±12.9)岁,P<0.05】;IPH组HVPG水平为(9.9±5.2)mmHg,显著低于NIPH组【(14.3±5.1)mmHg,P<0.05】;IPH组血清白蛋白和胆碱酯酶水平分别为(41.4±4.9)g/L和(6411.7±1839.3)U/L,显著高于NIPH组【分别为(33.9±6.1)g/L和(4438.5±1854.0)U/L,P<0.05】;IPH组腹水发生率显著低于NIPH组(27.3%对94.1%,P<0.01);腹水与HVPG高度相关(r=0.66,P<0.01),而消化道出血和食管胃底静脉曲张的发生与HVPG无显著性相关(r=0.193,P=0.324;r=-0.197,P=0.315);本组病例肝组织病理学共同特征为均无纤维化改变,但不同疾病有其独特的病理学表现。结论在NCPH患者中,现有的技术手段可以区分IPH与NIPH,了解每种疾病的临床特征有助于正确处理,改善预后。Objective The aim of this study was to summarize the clinical features and hepatic venous pressure gradient(HVPG)changes in patients with noncirrhotic portal hypertension(NCPH).Methods 28 patients with NCPH were admitted to our hospital between January 2017 and December 2019,the HVPG was measured and calculated by Seldinger from right venae jugularis interna,and the liver biopsies were performed.Results The patients with NCPH included 11 cases of idiopathic portal hypertension(IPH)and 17 cases of non-idiopathic portal hypertension(NIPH);the average age in patients with IPH was(40.6±15.8)yr,significantly younger than[(53.0±12.9)yr,P<0.05]in patients with NIHP;the HVPG in patients with IPH was(9.9±5.2)mmHg,significantly lower than[(14.3±5.1)mmHg,P<0.05]in patients with NIPH;serum albumin and cholinesterase levels in patients with IPH were(41.4±4.9)g/L and(6411.7±1839.3)U/L,significantly higher than[(33.9±6.1)g/L and(4438.5±1854.0)U/L,respectively,P<0.05]in patients with NIPH;the incidence of ascites in patients with IPH was much lower than that in patients with NIPH(27.3%vs.94.1%,P<0.01);the occurrence of ascites was positively correlated to(r=0.66,P<0.01),while the gastrointestinal bleeding and varices were not correlated to HVPG level(r=0.193,P=0.324;r=-0.197,P=0.315);the different entities in our series had their unique histopathological manifestations with common pathological features of non-fibrosis.Conclusion The common clinical approaches could differentiate IPH from NIPH in patients with NCPH,and the correct diagnosis might help dealing with them personally and appropriately.

关 键 词：非肝硬化门脉高压 特发性门脉高压 非特发性门脉高压 肝静脉压力梯度 特征 

分 类 号：R575.2[医药卫生—消化系统]