脐静脉开放在肝硬化疾病进展中的作用研究
发布时间：2018-12-12 18:16
【摘要】：背景:肝硬化是慢性肝病患者的终末期改变,肝硬化最显著的特征是门静脉高压,而侧支循环形成是门脉高压的主要特点之一,其中脐静脉开放是侧支循环开放中比较常见的一种类型,但脐静脉开放对肝硬化患者的临床意义尚不清楚。目的:研究肝硬化患者合并脐静脉开放的临床特点,探讨其与肝功能受损情况、肝性脑病、腹水、门静脉血栓、食管胃底静脉曲张、以及消化道出血的关系,探讨脐静脉开放的临床意义。材料与方法:收集2012.01-2015.10期间就诊于南昌大学第二附属医院消化内科的肝硬化患者,以CT结合其他临床指标进行诊断。通过CT判断是否存在脐静脉开放,随机抽取部分脐静脉未开放患者作为对照。收集这些患者一般情况、病史特点、血清生化指标、电子胃镜、腹部彩超及腹部CT等资料,然后使用SPSS17.0软件进行统计分析。结果:共确诊247例肝硬化患者,其中有脐静脉开放50例,脐静脉开放率为20.2%。脐静脉开放和未开放两组对比白蛋白、胆红素、INR、肌酐的95%CI分别为-2.48~0.54(P1=0.206),-31.6~4.34(P2=0.99),-0.15~0.15(P3=0.457),-22.0~10.0(P4=0.134),脐静脉开放对这些值没有影响。Child-Pugh分级为A级占8.7%,B级占42%,C级占49.3%(P0.05),两组的MELD评分R值分别是7.94±5.87、6.67±4.69(P0.05),脐静脉开放可以降低Child-Pugh分级,但不能改变MELD评分。脐静脉开放组患者肝性脑病的发生率有20%,而脐静脉未开放组肝性脑病发生率有14%,脐静脉开放会增加肝性脑病的发生(P0.05)。脐静脉开放不能减少腹水形成(P0.05)。脐静脉开放组无食管胃底静脉曲张占10%,重度曲张占48%,脐静脉未开放组无食管胃底静脉曲张占11%,重度曲张占54%(P0.05);脐静脉开放组消化道出血率占32%(16/50),脐静脉未开放组占39%(39/100)(P0.05),脐静脉开放不能降低食管胃底静脉的形成和出血。脐静脉开放组患者门静脉血栓形成率为8%,脐静脉未开放组为12%(P0.05);门静脉海绵样变性脐静脉开放组0例,脐静脉未开放组有8例(P0.05),脐静脉开放不能减少门静脉血栓形成,但无门静脉海绵样变性发生。结论:脐静脉开放不能减少出血和腹水,对门静脉血栓形成无影响。脐静脉开放可能降低Child-Pugh分级,但对MELD评分无影响,脐静脉开放后会增加肝性脑病的发生率。因此,脐静脉开放对肝硬化无积极的作用,可能是疾病进展的标志。
[Abstract]:Background: cirrhosis is an end-stage change in patients with chronic liver disease. Portal hypertension is the most prominent feature of cirrhosis, and collateral circulation is one of the main characteristics of portal hypertension. Umbilical vein opening is a common type of collateral circulation, but the clinical significance of umbilical vein opening in patients with liver cirrhosis is not clear. Objective: to study the clinical features of cirrhotic patients complicated with umbilical vein opening and its relationship with hepatic dysfunction, hepatic encephalopathy, ascites, portal vein thrombosis, esophageal and gastric varices, and gastrointestinal bleeding. To explore the clinical significance of umbilical vein opening. Materials and methods: patients with liver cirrhosis who were admitted to the Department of Gastroenterology, second affiliated Hospital of Nanchang University during the period of 2012.01-2015.10 were diagnosed by CT combined with other clinical indexes. CT was used to determine whether umbilical vein was open or not. The data of general condition, history, serum biochemical index, electronic gastroscope, abdominal color ultrasound and abdominal CT were collected and analyzed by SPSS17.0 software. Results: a total of 247 patients with liver cirrhosis were diagnosed, including 50 cases of umbilical vein opening, the rate of umbilical vein opening was 20.2um. The 95%CI of albumin, bilirubin and INR, creatinine were -2.48 ~ 0.54 (P _ 1: 0.206), -31.6N _ 4.34 (P _ 2N _ (0.99), -0.15C _ (0.15) (P _ (3) P _ (0.457), respectively. -22.0n 10.0 (P40.134), umbilical vein opening had no effect on these values. Child-Pugh grade A accounted for 8.7% and B grade 49.3% (P 0.05). The MELD score R value of the two groups was 7.94 卤5.87 卤6.67 卤4.69 (P0.05). Umbilical vein opening could decrease the Child-Pugh grade, but could not change the MELD score. The incidence of hepatic encephalopathy in the open umbilical vein group was 20 and that in the non-open umbilical vein group was 14. The opening of the umbilical vein would increase the incidence of hepatic encephalopathy (P0.05). Umbilical vein opening could not reduce ascites formation (P0.05). In the open umbilical vein group, 10 cases were without esophageal and gastric fundus varices, 48 were severe varices, 11 were esophageal and gastric fundus varices, and 54% were severe varices (P0.05). The gastrointestinal bleeding rate was 32% (16 / 50) in the open umbilical vein group and 39% (39 / 100) in the non-open umbilical vein group (P0.05). The portal vein thrombosis rate was 8% in the open umbilical vein group and 12% in the non-open umbilical vein group (P0.05). There were 0 cases in cavernous portal vein open group and 8 cases in non-open umbilical vein group (P0.05). Umbilical vein opening could not reduce portal vein thrombosis, but there was no portal cavernous degeneration. Conclusion: umbilical vein opening can not reduce bleeding and ascites, and has no effect on portal vein thrombosis. Umbilical vein opening may decrease Child-Pugh grade, but has no effect on MELD score, and increases the incidence of hepatic encephalopathy after umbilical vein opening. Therefore, umbilical vein opening has no positive effect on cirrhosis and may be a marker of disease progression.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2
本文编号：2375070
[Abstract]:Background: cirrhosis is an end-stage change in patients with chronic liver disease. Portal hypertension is the most prominent feature of cirrhosis, and collateral circulation is one of the main characteristics of portal hypertension. Umbilical vein opening is a common type of collateral circulation, but the clinical significance of umbilical vein opening in patients with liver cirrhosis is not clear. Objective: to study the clinical features of cirrhotic patients complicated with umbilical vein opening and its relationship with hepatic dysfunction, hepatic encephalopathy, ascites, portal vein thrombosis, esophageal and gastric varices, and gastrointestinal bleeding. To explore the clinical significance of umbilical vein opening. Materials and methods: patients with liver cirrhosis who were admitted to the Department of Gastroenterology, second affiliated Hospital of Nanchang University during the period of 2012.01-2015.10 were diagnosed by CT combined with other clinical indexes. CT was used to determine whether umbilical vein was open or not. The data of general condition, history, serum biochemical index, electronic gastroscope, abdominal color ultrasound and abdominal CT were collected and analyzed by SPSS17.0 software. Results: a total of 247 patients with liver cirrhosis were diagnosed, including 50 cases of umbilical vein opening, the rate of umbilical vein opening was 20.2um. The 95%CI of albumin, bilirubin and INR, creatinine were -2.48 ~ 0.54 (P _ 1: 0.206), -31.6N _ 4.34 (P _ 2N _ (0.99), -0.15C _ (0.15) (P _ (3) P _ (0.457), respectively. -22.0n 10.0 (P40.134), umbilical vein opening had no effect on these values. Child-Pugh grade A accounted for 8.7% and B grade 49.3% (P 0.05). The MELD score R value of the two groups was 7.94 卤5.87 卤6.67 卤4.69 (P0.05). Umbilical vein opening could decrease the Child-Pugh grade, but could not change the MELD score. The incidence of hepatic encephalopathy in the open umbilical vein group was 20 and that in the non-open umbilical vein group was 14. The opening of the umbilical vein would increase the incidence of hepatic encephalopathy (P0.05). Umbilical vein opening could not reduce ascites formation (P0.05). In the open umbilical vein group, 10 cases were without esophageal and gastric fundus varices, 48 were severe varices, 11 were esophageal and gastric fundus varices, and 54% were severe varices (P0.05). The gastrointestinal bleeding rate was 32% (16 / 50) in the open umbilical vein group and 39% (39 / 100) in the non-open umbilical vein group (P0.05). The portal vein thrombosis rate was 8% in the open umbilical vein group and 12% in the non-open umbilical vein group (P0.05). There were 0 cases in cavernous portal vein open group and 8 cases in non-open umbilical vein group (P0.05). Umbilical vein opening could not reduce portal vein thrombosis, but there was no portal cavernous degeneration. Conclusion: umbilical vein opening can not reduce bleeding and ascites, and has no effect on portal vein thrombosis. Umbilical vein opening may decrease Child-Pugh grade, but has no effect on MELD score, and increases the incidence of hepatic encephalopathy after umbilical vein opening. Therefore, umbilical vein opening has no positive effect on cirrhosis and may be a marker of disease progression.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2
【参考文献】
相关期刊论文 前3条
1 石青;郭武华;;脐静脉的解剖特点及临床应用进展[J];中国临床解剖学杂志;2016年03期
2 蒋庆军;;内毒素检测在内毒素血症治疗中的应用[J];现代中西医结合杂志;2008年33期
3 徐卫华,吴性江,黎介寿;肝硬化和肠道通透性[J];肠外与肠内营养;2001年02期
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