门脉高压性胃病的临床分析
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摘要
目的：本研究旨在通过统计分析肝硬化患者并发门脉高压胃病与肝功能分级、门静脉内径、脾静脉内径、食管静脉曲张及食管曲张静脉套扎术等因素的关系。
方法：回顾分析吉林大学第一医院2009年1月至2011年1月在胃肠内科住院且根据临床表现、实验室检查、腹部彩超及内窥镜下检查明确诊断为肝硬化合且资料完整的患者168例统计分析。
诊断标准：PHG的诊断标准，PHG诊断标准参考McCormack分类法，McCormack分类法其将内镜下PHG所见分为轻度、重度：①轻度：淡粉红色样斑点或猩红热样疹；黏膜皱襞表面条索状发红;红斑呈剥脱样或镶嵌图案样外观，即红斑充血斑块，黏膜呈现细白网状类似蛇皮样表现；②重度：弥散性樱桃红样斑点或弥漫融合性出血性胃炎。
结果：1、168例肝硬化患者中合并门静脉高压性胃病96例（57.14%），并发食管静脉曲张142例（84.52%），根据胃镜下表现分为未出现PHG组、轻度组、重度组。2、门脉高压性胃病与肝功的关系：A级、B级、C级发生PHG分别为20例（11.9%）、57例（33.92%）、19例（11.3%），差异不存在统计学意义（P>0.05）。3、PHG与门静脉、脾静脉内径的关系：非PHG组门静脉为13.5±0.31cm，脾静脉为0.95±0.32cm，PHG组门静脉内径14.7±0.38cm，脾静脉内径为0.92±0.25cm，两者门静脉内径差异存在统计学意义（P＜0.05），脾静脉内径差异无统计学意义（P>0.05），行Spearman相关性分析提示门静脉内径与PHG正相关。门静脉内径宽度的增大提示门脉高压性胃病的发生率提高。4、PHG与食管曲张静脉分级及内镜下食管曲张静套扎术的关系：统计肝硬化患者168例，出现食管静脉曲张142例（84.52%），轻度EV发生PHG为10例（7%），中度EV为25例（17.6%），重度EV为61例（42.96%），差异存在统计学意义（P＜0.05），行Spearman相关性分析PHG与食管曲张静脉严重程度不存在相关性（P>0.05），168例患者中选取行套扎治疗48例，排除复查期间因食管胃底静脉曲张破裂出血的患者或长期口服普萘洛尔等影响门脉压力的患者，分别于1-3个月、3-5个月后复查，比较食管曲张静脉套扎术后PHG的发病情况，差异存在统计学意义（P＜0.05），比较治疗前发病率的95%可信区间为28%-56%、第一次复查后发病率95%可信区间49%-76%、第二次复查发病率95%可信区间67%-91%，比较发现第二次复查与治疗前发病率可信区间无重合，考虑治疗后PHG发病率升高。
结论：（1）门脉高压性胃病与肝功无关。（2)门静脉内径越宽，门脉高压性胃病发病率越高，脾静脉内径与门脉高压性胃病无关。（3）食管静脉曲张程度越重，门脉高压性胃病发病率越高，但两者严重程度不相关，行内镜下食管曲张静脉套扎治疗前后比较门脉高压性胃病存在统计学意义，食管曲张静脉套扎术后PHG发病率升高。
Objective:to analysis the relationship of portal hypertensive gastropathy and five clinical factors such as liver function, portal vein, splenic vein, esophageal varices, endoscopic treatment through the statistical.
Methods:168case is randomly selected from2009to2011in the first hospital of jilin university.In accordance with the endoscopic manifestations of PHG, the patines can be divided into three groups, we compare the liver function, portal vein, splenic vein, esophageal varices and endoscopic therapy between groups
Diagnostic criteria the diagnostic standard of PHG is the classification of McCormack, it divided into PHG into mild, severe by the endoscopic, the mild: pale pink and scarlet fever-like rash sample spots; mucosal surface of cords redness; erythema in exfoliative sample or mosaic appearance, namely erythema with plaques, mucosa appears white mesh like snakeskin sample performance; the severe:diffuse cherry erythroid-like spots or diffuse confluent hemorrhagic gastritis
Results:168cases of liver cirrhosis patients complicated with PHG was96(57.14%), complicated with esophageal varices was142(84.52%), the child-pugh degree A was20(11.9%), the child-pugh degree B was57(33.92%), the child-pugh degree C was19(11.3%), the portal vein and spleen vein of PHG group is13.5+0.31cm,0.92+0.25cm,versus the other group is14.7+0.38cm,0.95+0.32cm,the light EV of PHG was10(7%),the moderate EV of PHG was25(17.6%),the severe EV of PHG was61(42.96%), There were statistically significant differences (p<0.05), there were statistically significant difference comparing the PHG after endoscopic treatment (p<0.05).
Conclusion There were not statistically significant differences between PHG and liver function, Portal vein and PHG have positive relation, PHG and esophageal varices have positive correlation, it can illustrate endoscopic ligation have relation with PHG.
方法：回顾分析吉林大学第一医院2009年1月至2011年1月在胃肠内科住院且根据临床表现、实验室检查、腹部彩超及内窥镜下检查明确诊断为肝硬化合且资料完整的患者168例统计分析。
诊断标准：PHG的诊断标准，PHG诊断标准参考McCormack分类法，McCormack分类法其将内镜下PHG所见分为轻度、重度：①轻度：淡粉红色样斑点或猩红热样疹；黏膜皱襞表面条索状发红;红斑呈剥脱样或镶嵌图案样外观，即红斑充血斑块，黏膜呈现细白网状类似蛇皮样表现；②重度：弥散性樱桃红样斑点或弥漫融合性出血性胃炎。
结果：1、168例肝硬化患者中合并门静脉高压性胃病96例（57.14%），并发食管静脉曲张142例（84.52%），根据胃镜下表现分为未出现PHG组、轻度组、重度组。2、门脉高压性胃病与肝功的关系：A级、B级、C级发生PHG分别为20例（11.9%）、57例（33.92%）、19例（11.3%），差异不存在统计学意义（P>0.05）。3、PHG与门静脉、脾静脉内径的关系：非PHG组门静脉为13.5±0.31cm，脾静脉为0.95±0.32cm，PHG组门静脉内径14.7±0.38cm，脾静脉内径为0.92±0.25cm，两者门静脉内径差异存在统计学意义（P＜0.05），脾静脉内径差异无统计学意义（P>0.05），行Spearman相关性分析提示门静脉内径与PHG正相关。门静脉内径宽度的增大提示门脉高压性胃病的发生率提高。4、PHG与食管曲张静脉分级及内镜下食管曲张静套扎术的关系：统计肝硬化患者168例，出现食管静脉曲张142例（84.52%），轻度EV发生PHG为10例（7%），中度EV为25例（17.6%），重度EV为61例（42.96%），差异存在统计学意义（P＜0.05），行Spearman相关性分析PHG与食管曲张静脉严重程度不存在相关性（P>0.05），168例患者中选取行套扎治疗48例，排除复查期间因食管胃底静脉曲张破裂出血的患者或长期口服普萘洛尔等影响门脉压力的患者，分别于1-3个月、3-5个月后复查，比较食管曲张静脉套扎术后PHG的发病情况，差异存在统计学意义（P＜0.05），比较治疗前发病率的95%可信区间为28%-56%、第一次复查后发病率95%可信区间49%-76%、第二次复查发病率95%可信区间67%-91%，比较发现第二次复查与治疗前发病率可信区间无重合，考虑治疗后PHG发病率升高。
结论：（1）门脉高压性胃病与肝功无关。（2)门静脉内径越宽，门脉高压性胃病发病率越高，脾静脉内径与门脉高压性胃病无关。（3）食管静脉曲张程度越重，门脉高压性胃病发病率越高，但两者严重程度不相关，行内镜下食管曲张静脉套扎治疗前后比较门脉高压性胃病存在统计学意义，食管曲张静脉套扎术后PHG发病率升高。
Objective:to analysis the relationship of portal hypertensive gastropathy and five clinical factors such as liver function, portal vein, splenic vein, esophageal varices, endoscopic treatment through the statistical.
Methods:168case is randomly selected from2009to2011in the first hospital of jilin university.In accordance with the endoscopic manifestations of PHG, the patines can be divided into three groups, we compare the liver function, portal vein, splenic vein, esophageal varices and endoscopic therapy between groups
Diagnostic criteria the diagnostic standard of PHG is the classification of McCormack, it divided into PHG into mild, severe by the endoscopic, the mild: pale pink and scarlet fever-like rash sample spots; mucosal surface of cords redness; erythema in exfoliative sample or mosaic appearance, namely erythema with plaques, mucosa appears white mesh like snakeskin sample performance; the severe:diffuse cherry erythroid-like spots or diffuse confluent hemorrhagic gastritis
Results:168cases of liver cirrhosis patients complicated with PHG was96(57.14%), complicated with esophageal varices was142(84.52%), the child-pugh degree A was20(11.9%), the child-pugh degree B was57(33.92%), the child-pugh degree C was19(11.3%), the portal vein and spleen vein of PHG group is13.5+0.31cm,0.92+0.25cm,versus the other group is14.7+0.38cm,0.95+0.32cm,the light EV of PHG was10(7%),the moderate EV of PHG was25(17.6%),the severe EV of PHG was61(42.96%), There were statistically significant differences (p<0.05), there were statistically significant difference comparing the PHG after endoscopic treatment (p<0.05).
Conclusion There were not statistically significant differences between PHG and liver function, Portal vein and PHG have positive relation, PHG and esophageal varices have positive correlation, it can illustrate endoscopic ligation have relation with PHG.
引文
[1]Viggiano TR, Gostout CJ. Portal hypertensive intestinal vasculopathy: a review of the clinical, endoscopic, and histopathologic features [J].Am J Gastoenterol,1992,87(8):944-954
[2]赵敏,金瑞.门脉高压性胃病的研究进展[J].临床肝胆病杂志,2006,22(3)：225-226.
[3]Tomikawa M, Akiba Y, Kaunitz JD, etal. New insights into impairment of mucosal defense in portal hypertensive gastric mucosa [J].J Gastrointest Surg,2000,4(5):458-463.
[4]Daisuke Watanabe, Bichiro Otaka. Expression of a72-kDa heatshock prot-ein, and its cytop rotective function, in gastric mucosa in cirrhotic rats[J]. J Gastroenterol,2004,39:724-733.
[5]王凝,展玉涛,高福生.肝硬化门脉高压性胃病大鼠胃黏膜iNOS的表达[J].山东医学,2009,49(28)：24-25.
[6]Wu B, Zeng L, Lin Y, Wen Z, Chen G, Iwakiri R, Fujimoto K. Downre-gulation of cyclooxygenase-1is involved in gastric mucosal apoptosis via death signaling in portal hypertensive rats.[J]. Cell Res2009Nov;19(11):1269-78.
[7]张琪,张翠萍,戴莉玲.门脉高压胃病患者胃泌素、生长抑素、胰高血糖的变化[J].临床肝胆杂志,2006,22(4)：279-280.
[8]商中华,张波,陈海云等.血管内皮生长因子及其受体在门脉高压性胃病中的表达及其意义[J].中国综合临床2007；23：226-227
[9]白云,姜慧卿,路新卿等.血管内皮生长因子在门脉高压患者胃黏膜的表达[J].胃肠病学和肝病学杂志2007；16：63-65
[10]Burak KW, Lee SS, Beck PL. Portal hypertensive gastropathy and gastric antral vascular ectasia (GAVE) syndrome [J]. Gut,2001,49(6):866-72
[11]龚飞跃,曲洁新.肝硬化门脉高压病人胃黏膜改变[J].中国实用内科杂志,1998,18(1)：31.
[12]宗晔,赵海英,吴咏东.肝硬化患者门静脉高压性胃病发病因素的研究[J].胃肠病学,2006,11(5)：298-300.
[13]黄蔚,陈岳详VEGF、TGF-β1在门脉高压性胃病中的作用研究[J].中国医药指南,2009,7(7)：38-39.
[14]蔡任军,谢志斌.门脉高压性胃病的多因素分析[J].广东医学.2006,27(9)：1316-1317.
[15]张晓红,郑荣琴,卢翠蓉.超声检查对肝硬化门脉高压性胃病的预测[J].临床肝胆病杂志,2004,20(1)：30-31.
[16]王云溪,毛建娜,歧红阳.肝硬化门脉高压性胃病与幽门螺杆菌感染关系探讨[J].职业与健康,2010,7,26(13)：1546-1547.
[17]D'amico G, Montalbano L, TrainaM, etal. Nature history of congestive gastropathy in cirrhosis [J]. Gastroenterology,1990,99(6):1558-64.
[18]Mccormack TT, Sims J, Eyre-brook I, etal. Gastric lesions in portal hypertension:inflammatory gastritis or congestive gastropathy [J]. Gut,1985,26(11):1226-1232.
[19]Primignani M, Carpinelli L, Preatoni P, etal. Natural history of por2tal hypertensive gastropathy in patients with liver cirrhosis. The New Italian Endoscop ic Club for the study and treatment of esophageal vari2ces (NIEC)[J]. Gastroenterology,2000,119(1):181-187.
[20]Tanoue K, Hashizume M, Weda H, etal. Effectsof endoscopic injection sclerothe-rapy on portal hypertensive gastropathy:a prospective study [J]. Gastrointest Endosc,1992,38(5):582-585.
[21]Lo GH, Lai KH, Cheng JS, Hsu PI, Chen TA, Wang EM, Lin CK, Chiang HT. The effects of endoscopic variceal ligation and propranolol on portal hypertensive gastropathy:a prospective, controlled trial [J]. Gastrointest Endosc2001;53:579-584.
[22]黄会芳,霍丽娟,吴晓宁.汉防己甲素对肝硬化大鼠胃黏膜微循环及超微结构的影响[J].世界华人消化杂志,2007；15：2337-2340
[23]Le Q, Zhang X, Zhang J, etal. Effects of sandostat in on gastric mucosal perfusion in rats with portal hypertensive gastropathy[J].Zhonghua GanZang Bing Za Zhi2000,8:232-4.
[24]周永宁,彭贵勇,吴静等.奥曲肽、垂体后叶素和奥美拉唑治疗门脉高压性胃病急性出血的对照研究[J].世界华人消化杂志,2002,10(2)：197-199，
[25]Blei AT, Groszmann RJ, Gusberg R. Comparison of vasopressin and triglycyl-lysine vasopressin on splanchnic and systemic hemodynamics in dogs [J]. Dig Dis Sci,1980,25:688-94
[26]Trevino HH, Brady CE3rd, Schenker S. Portal hypertensive gastro-pathy[J]. Dig Dis1996;14:258-270
[27]杨晓钟,王琼,周锡荣.门静脉高压性胃病并出血的诊治[J].中华消化内镜杂志,2002,19(1)：31-32.
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[2]赵敏,金瑞.门脉高压性胃病的研究进展[J].临床肝胆病杂志,2006,22(3)：225-226.
[3]Tomikawa M, Akiba Y, Kaunitz JD, etal. New insights into impairment of mucosal defense in portal hypertensive gastric mucosa [J].J Gastrointest Surg,2000,4(5):458-463.
[4]Daisuke Watanabe, Bichiro Otaka. Expression of a72-kDa heatshock prot-ein, and its cytop rotective function, in gastric mucosa in cirrhotic rats[J]. J Gastroenterol,2004,39:724-733.
[5]王凝,展玉涛,高福生.肝硬化门脉高压性胃病大鼠胃黏膜iNOS的表达[J].山东医学,2009,49(28)：24-25.
[6]Wu B, Zeng L, Lin Y, Wen Z, Chen G, Iwakiri R, Fujimoto K. Downre-gulation of cyclooxygenase-1is involved in gastric mucosal apoptosis via death signaling in portal hypertensive rats.[J]. Cell Res2009Nov;19(11):1269-78.
[7]张琪,张翠萍,戴莉玲.门脉高压胃病患者胃泌素、生长抑素、胰高血糖的变化[J].临床肝胆杂志,2006,22(4)：279-280.
[8]商中华,张波,陈海云等.血管内皮生长因子及其受体在门脉高压性胃病中的表达及其意义[J].中国综合临床2007；23：226-227
[9]白云,姜慧卿,路新卿等.血管内皮生长因子在门脉高压患者胃黏膜的表达[J].胃肠病学和肝病学杂志2007；16：63-65
[10]Burak KW, Lee SS, Beck PL. Portal hypertensive gastropathy and gastric antral vascular ectasia (GAVE) syndrome [J]. Gut,2001,49(6):866-72
[11]龚飞跃,曲洁新.肝硬化门脉高压病人胃黏膜改变[J].中国实用内科杂志,1998,18(1)：31.
[12]宗晔,赵海英,吴咏东.肝硬化患者门静脉高压性胃病发病因素的研究[J].胃肠病学,2006,11(5)：298-300.
[13]黄蔚,陈岳详VEGF、TGF-β1在门脉高压性胃病中的作用研究[J].中国医药指南,2009,7(7)：38-39.
[14]蔡任军,谢志斌.门脉高压性胃病的多因素分析[J].广东医学.2006,27(9)：1316-1317.
[15]张晓红,郑荣琴,卢翠蓉.超声检查对肝硬化门脉高压性胃病的预测[J].临床肝胆病杂志,2004,20(1)：30-31.
[16]王云溪,毛建娜,歧红阳.肝硬化门脉高压性胃病与幽门螺杆菌感染关系探讨[J].职业与健康,2010,7,26(13)：1546-1547.
[17]D'amico G, Montalbano L, TrainaM, etal. Nature history of congestive gastropathy in cirrhosis [J]. Gastroenterology,1990,99(6):1558-64.
[18]Mccormack TT, Sims J, Eyre-brook I, etal. Gastric lesions in portal hypertension:inflammatory gastritis or congestive gastropathy [J]. Gut,1985,26(11):1226-1232.
[19]Primignani M, Carpinelli L, Preatoni P, etal. Natural history of por2tal hypertensive gastropathy in patients with liver cirrhosis. The New Italian Endoscop ic Club for the study and treatment of esophageal vari2ces (NIEC)[J]. Gastroenterology,2000,119(1):181-187.
[20]Tanoue K, Hashizume M, Weda H, etal. Effectsof endoscopic injection sclerothe-rapy on portal hypertensive gastropathy:a prospective study [J]. Gastrointest Endosc,1992,38(5):582-585.
[21]Lo GH, Lai KH, Cheng JS, Hsu PI, Chen TA, Wang EM, Lin CK, Chiang HT. The effects of endoscopic variceal ligation and propranolol on portal hypertensive gastropathy:a prospective, controlled trial [J]. Gastrointest Endosc2001;53:579-584.
[22]黄会芳,霍丽娟,吴晓宁.汉防己甲素对肝硬化大鼠胃黏膜微循环及超微结构的影响[J].世界华人消化杂志,2007；15：2337-2340
[23]Le Q, Zhang X, Zhang J, etal. Effects of sandostat in on gastric mucosal perfusion in rats with portal hypertensive gastropathy[J].Zhonghua GanZang Bing Za Zhi2000,8:232-4.
[24]周永宁,彭贵勇,吴静等.奥曲肽、垂体后叶素和奥美拉唑治疗门脉高压性胃病急性出血的对照研究[J].世界华人消化杂志,2002,10(2)：197-199，
[25]Blei AT, Groszmann RJ, Gusberg R. Comparison of vasopressin and triglycyl-lysine vasopressin on splanchnic and systemic hemodynamics in dogs [J]. Dig Dis Sci,1980,25:688-94
[26]Trevino HH, Brady CE3rd, Schenker S. Portal hypertensive gastro-pathy[J]. Dig Dis1996;14:258-270
[27]杨晓钟,王琼,周锡荣.门静脉高压性胃病并出血的诊治[J].中华消化内镜杂志,2002,19(1)：31-32.
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