肝移植术后食管静脉曲张患者的临床特点与风险因素  

The characteristics and risk factors of esophageal varices in patients post-liver transplantation

作　　者：向璐 张利娟 杨俊连 张达利 冯丹妮 XIANG Lu;ZHANG Li-juan;YANG Jun-lian;ZHANG Da-li;FENG Dan-ni(Senior Department of Hepatology,the Fifth Medical Center of Chinese People′s Liberation Army General Hospital,Beijing 100039,China;Senior Department of Infectious Diseases,the Fifth Medical Center of Chinese People′s Liberation Army General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第五医学中心肝病医学部,北京100039 [2]解放军总医院第五医学中心感染病医学部,北京100039

出　　处：《肝脏》2024年第1期44-46,共3页Chinese Hepatology

摘　　要：目的探索肝移植术后食管静脉曲张患者的临床特点与风险因素。方法本研究为横断面研究。回顾性分析2011年7月至2021年10月于解放军总医院第五医学中心行胃镜检查的肝移植术后患者55例,其中存在食管静脉曲张患者26例,无食管静脉曲张患者29例。比较两组患者的临床特征,分析肝移植术后发生食管静脉曲张的影响因素。结果与没有食管静脉曲张患者比较,有静脉曲张患者的脾脏长度更长(117 mm比154 mm)、血小板水平更低(136×109/L比87×109/L)、总胆汁酸水平更高(6.0μmol/L比24.5μmol/L),差异均有统计学意义(均P<0.05)。脾脏长度是肝移植术后发生食管静脉曲张的独立危险因素(OR:1.063,95%CI:1.01~1.12,P=0.031)。脾脏长度预测合并食管静脉曲张的ROC曲线下面积为0.790(95%CI:0.647~0.934,P=0.001),cutoff值为143mm,敏感度为65.0%,特异度为91.3%。结论脾脏长度是肝移植术后患者出现食管静脉曲张的独立危险因素,对食管静脉曲张有较好的预测效能。Objective To explore the risk factors and characteristics of esophageal varices in patients post-liver transplantation(LT).Methods This is a cross-section study retrospectively analyzed the data of patients post-LT who had a gastroscopy at the General hospital of the 5th medical center of Chinese People′s Liberation Army from July 2011 to October 2021.Patients post-LT were classified into patients with and without esophageal varices via gastroendoscopy.Results Fifty-five cases were included in this study,with 26 patients among them with esophageal varices,and 29 cases without esophageal varices.Compared with those patients without esophageal varices,patients with esophageal varices had three characteristics:longer spleen length(117 mm vs 154 mm,P=0.001),lower platelet counts(136×109/L vs 87×109/L,P=0.015),and higher total bile acid level(6.0μmol/L vs 24.5μmol/L,P=0.001).Spleen length(OR=1.063,95%CI=1.01~1.12,P=0.031)was the independent risk factor associated with esophageal varices.The area under the ROC curve for esophageal varices was 0.790(95%CI=0.647~0.934,P=0.001)at the cutoff value was 143mm,the sensitivity was 91.3%,and specificity was 91.3%.Conclusion Spleen length is the independent risk factor associated with esophageal varices and had good discriminable power for esophageal varices after LT.

关 键 词：肝移植术后 食管静脉曲张 脾脏 血小板 胆汁酸 

分 类 号：R657.3[医药卫生—外科学]