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目的探讨早期原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)伴食管静脉曲张的发生率及相关危险因素,为PBC患者并发食管静脉曲张的预防和治疗提供理论依据。方法收集1990年1月至2004年1月期间于本院经肝活检诊断明确的244例PBC患者(早期PBC患者208例,进展期PBC患者36例)的临床资料进行回顾性分析,并对208例无食管静脉曲张的早期PBC患者进行分析。对食管静脉曲张发生相关因素进行logistic回归分析。结果 18例PBC患者就诊时已发现食管静脉曲张。食管静脉曲张在进展期PBC患者中比例(22.2%,8/36)明显高于早期PBC患者(4.8%,10/208),差异有统计学意义(P<0.01),且伴静脉曲张较无静脉曲张患者有更多肝脏疾病特征。早期PBC患者中伴静脉曲张的患者较不伴静脉曲张患者年龄大,且碱性磷酸酶(ALP)比值高,差异均有统计学意义(P<0.05)。ALP比值和免疫球蛋白G(Ig G)水平的升高及血小板计数的降低与PBC患者食管静脉曲张的发生密切相关(P<0.01),但Mayo风险评分并未表现相关性。在早期PBC患者中,ALP比值升高及血小板计数降低与食管静脉曲张的发生存在显著相关性(P<0.01);进展期PBC患者Ig G水平升高与食管静脉曲张发生存在显著相关性(P<0.05)。无食管静脉曲张的早期PBC患者,高ALP比值及低血小板计数与随访期食管静脉曲张的发生呈显著相关性(P<0.01,P<0.05),按相关危险因素分组分析,发现诊断时ALP比值≥1.9的患者食管静脉曲张的发生率高于ALP比值<1.9的患者,差异有统计学意义(P<0.05)。结论诊断时ALP比值升高以及随访期间血小板计数下降对于早期PBC患者食管静脉曲张发生的预测具有一定临床意义。
Objective To investigate the incidence of early primary biliary cirrhosis (PBC) with esophageal varices and related risk factors, and to provide a theoretical basis for the prevention and treatment of esophageal varices in patients with PBC. Methods A retrospective analysis was performed on the clinical data of 244 patients with PBC diagnosed in our hospital from January 1990 to January 2004 (208 patients with early PBC and 36 patients with advanced PBC). The data of 208 Cases of early PBC without esophageal varices were analyzed. The incidence of esophageal varices related factors logistic regression analysis. Results Eighteen patients with PBC had esophageal varices at the time of their visit. Esophageal varices in advanced PBC patients (22.2%, 8/36) was significantly higher than the early PBC patients (4.8%, 10/208), the difference was statistically significant (P <0.01), and with varicose veins Patients with varices have more liver disease characteristics. Patients with early PBC patients with varicose veins were older patients without varices, and the ratio of alkaline phosphatase (ALP) was higher, the difference was statistically significant (P <0.05). ALP ratio and IgG level and platelet count were closely related to the occurrence of esophageal varices in PBC patients (P <0.01), but the Mayo risk score did not show any correlation. There was a significant correlation between ALP ratio and platelet count in patients with early PBC and esophageal varices (P <0.01). There was a significant correlation between IgG level and esophageal varices in advanced PBC patients (P <0.05). In patients with early PBC without esophageal varices, the high ALP ratio and low platelet count were significantly correlated with the occurrence of esophageal varices at follow-up (P <0.01, P <0.05). According to the analysis of risk factors, the ALP ratio The incidence of esophageal varices ≥1.9 was significantly higher than that of patients with ALP <1.9 (P <0.05). Conclusions The higher ALP ratio at diagnosis and the lower platelet count during follow-up may be of clinical significance for the prediction of esophageal varices in patients with early PBC.