肝硬化患者门静脉直径与临床指标相关性分析

发布时间：2018-11-22 18:39

【摘要】：目的:门静脉直径可作为反应门脉压力的良好指标,探索与门静脉主干直径相关的实验室指标和临床表现,为门脉压力综合评估寻找更多更可靠的参考证据,指导临床上门脉高压患者诊治。方法:回顾性分析2016年于吉林大学第一临床医院肝胆胰内科住院肝硬化患者409例,(1)排除肝脏、门脉系统占位性病变患者及数据不完善者223例,最终纳入186例患者作为研究对象,分为门静脉直径1.3cm组;门静脉直径1.3-1.5cm组;门静脉直径1.5cm组。(2)经CT平扫+增强检查明确诊断为门脉高压伴侧支循环开放者共151例,并根据影像学结果分为伴有脾-肾分流组与不伴有脾-肾分流组。收集患者血清学及影像学资料,通过SPSS软件进行分析,计算出与门脉高压相关的指标。结果:1、门静脉直径分组与CHILD分级构成比之间没有差异性;CHILD分级A级与B级,B级与C级间门静脉直径差异在统计学上有意义(P0.05),但A级与C级之间无明显差异(P0.05)。2、血小板、白细胞、GGT、凝血酶时间在不同门静脉直径分级中有明显差异。随着门静脉直径分级加重,血小板、白细胞逐渐减少,凝血酶时间逐渐缩短,GGT逐渐降低。3、血小板计数、白细胞、平均红细胞体积、凝血酶时间、GGT与门静脉直径呈正相关,FIB-4、脾脏指数与门静脉直径呈负相关。4、脾功能亢进和侧支循环开放发生率在门静脉直径分组间具有明显差异(P=0.00,0.01),肝性脑病、腹腔积液发生率在门静脉直径分组间没有明显差异(P0.05)。5、分流组腹腔积液、肿瘤的发生率较无分流组明显增加,差异具有统计学意义,(P0.05),并且分流组女性患者的患病率明显大于无分流组(P=0.03,0.05)。而消化道出血的发生率差异不明显(P=0.05),肝性脑病、感染、肝掌、蜘蛛痣的发生率在两组间无差异(P0.05)。结论:1、门脉高压与肝脏功能减退存在相关性,伴随着肝功能逐渐下降,起初门脉高压逐渐加重,但随着肝功能进一步下降,门脉压力反而有所缓解。2、伴随着门脉高压加重,凝血酶时间缩短、GGT下降,有待进一步研究。3、伴随着门脉高压加重,脾脏充血肿大,脾功能亢进加重,白细胞、血小板下降明显,脾功能亢进与侧支循环开放发生率明显增加。
[Abstract]:Objective: the diameter of portal vein can be used as a good index to reflect portal vein pressure, to explore the laboratory indexes and clinical manifestations related to the diameter of portal vein, and to find more and more reliable reference evidence for the comprehensive evaluation of portal vein pressure. To guide clinical diagnosis and treatment of portal hypertension. Methods: a retrospective analysis was made on 409 cases of liver cirrhosis in the Department of Hepatobiliary and Pancreatic Medicine of the first Clinical Hospital of Jilin University in 2016. Finally, 186 patients were divided into portal vein diameter 1.3cm group. Portal vein diameter 1.3-1.5cm group; Portal vein diameter 1.5cm group. (2) Fifty-one patients with portal hypertension with collateral circulation were diagnosed by CT plain contrast enhanced scan. According to the imaging results, they were divided into two groups: spleno-renal shunt group and non-spleno-renal shunt group. The serum and imaging data were collected and analyzed by SPSS software, and the indexes related to portal hypertension were calculated. Results: 1, there was no difference between portal vein diameter grouping and CHILD grade composition ratio; CHILD grade A and B, B grade and C grade had significant difference in portal vein diameter (P0.05), but there was no significant difference between A grade and C grade (P0.05). 2, platelets, white blood cells, GGT,. Thrombin time was significantly different in different portal vein diameter classification. With the gradation of portal vein diameter, platelets and leukocytes gradually decreased, thrombin time decreased, GGT decreased gradually, platelet count, white blood cell, mean erythrocyte volume, thrombin time, GGT was positively correlated with portal vein diameter, FIB-4, spleen index was negatively correlated with portal vein diameter. 4. The incidence of hypersplenism and collateral circulation opening was significantly different among portal vein diameter groups (P0. 000. 01), hepatic encephalopathy. There was no significant difference in the incidence of peritoneal effusion among portal vein diameter groups (P0.05). The incidence of tumor in shunt group was significantly higher than that in non-shunt group (P0.05). The prevalence rate of shunt group was significantly higher than that of no shunt group (P < 0.05). However, there was no significant difference in the incidence of gastrointestinal hemorrhage (P0. 05). There was no difference in the incidence of hepatic encephalopathy, infection, hepatic palmar and spider nevus between the two groups (P0.05). Conclusion: 1. Portal hypertension has a correlation with hepatic dysfunction. With the decrease of liver function, portal hypertension gradually increases at first, but with the further decrease of liver function, portal pressure is relieved. 2. With the exacerbation of portal hypertension, the shortening of thrombin time and the decrease of GGT, further research is needed. 3. With the exacerbation of portal hypertension, splenomegaly, hypersplenism, leukopenia, platelets decrease obviously. The incidence of hypersplenism and collateral circulation was significantly increased.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2

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