肝硬化门静脉高压性胃病的胃镜表现及相关因素分析

目的探讨门静脉高压性胃病(PHG)胃镜下胃黏膜特征及其与食管胃静脉曲张、溃疡病及肝硬化并发症之间的关系。方法回顾性分析2012年8月-2018年6月陆军军医大学大坪医院867例肝硬化患者临床资料,统计其胃镜下食管胃静脉曲张、PHG、溃疡病发生的情况,收集肝硬化并发自发性细菌性腹膜炎、肝性脑病、原发性肝癌的数据资料。计数资料组间比较采用χ2检验,相关性分析采用Spearman相关性检验。结果肝硬化患者PHG发生率高达66.2%(574/867),轻度PHG胃黏膜改变以红点灶(68.6%)和蛇皮征(56.8%)为主,而重度PHG以弥漫红斑为主(76.5%)。PHG在不同程度的食管静脉曲张中发生率差异显著(χ2=304.712,P<0.05),并且随着食管静脉曲张加重,PHG程度亦越来越重(r=0.515,P<0.05)。不同程度胃静脉曲张的患者PHG发生率差异有统计学意义(χ2=81.004,P<0.05),且PHG程度与胃静脉曲张程度相关(r=0.292,P<0.05)。不同部位静脉曲张患者PHG的发生率差异显著(χ2=41.361,P<0.05),当患者仅出现胃静脉曲张时,PHG发生率(34.8%)最低,且均为轻度;而食管和胃均出现静脉曲张时,PHG发生率(85.6%)最高。未合并PHG患者中有71例(24.2%)因呕血和(或)黑便就诊住院,而574例PHG患者中有316例(55.1%)因此而住院,二者差异显著(χ2=74.562,P<0.05)。结论不同PHG严重程度的患者胃黏膜特征差异显著,PHG的发生和严重程度与食管胃静脉曲张程度密切相关,且是肝硬化消化道出血重要原因,应积极治疗和预防PHG以降低消化道出血风险和相关并发症。

Gastroscopic manifestations of portal hypertensive gastropathy in liver cirrhosis and related factors

Objective To investigate the gastroscopic manifestations of gastric mucosa in portal hypertensive gastropathy(PHG)and the association of PHG with gastroesophageal varices,ulcers,and liver cirrhosis complications.Methods A retrospective analysis was performed for the clinical data of 867 patients with liver cirrhosis who were treated in Daping Hospital of Army Medical University from August 2012 to June 2018,and the incidence rates of gastroesophageal varices,PHG,and ulcers were recorded.Meanwhile,the data of spontaneous bacterial peritonitis(SBP),hepatic encephalopathy(HE),and hepatocellular carcinoma(HCC)were collected.The chi-square test was used for comparison of categorical data between groups,and a Spearman correlation analysis was also performed.Results The incidence rate of PHG in the patients with liver cirrhosis reached 66.2%(574/867),and gastric mucosa abnormalities in mild PHG were mainly red-spot lesions(68.6%)and snakeskin(56.8%),while diffuse erythema(76.5%)was the main gastric mucosa abnormality in severe PHG.There was a significant difference in the incidence rate of PHG between the patients with different severities of esophageal varices(χ2=304.712,P<0.05),and the severity of PHG increased with the aggravation of esophageal varices(r=0.515,P<0.05).There was a significant difference in the incidence rate of PHG between the patients with different severities of gastric varices(χ2=81.004,P<0.05),and the severity of PHG was positively correlated with that of gastric varices(r=0.292,P<0.05).There was a significant difference in the incidence rate of PHG between the patients with varices at different locations(χ2=41.361,P<0.05);the patients with gastric varices alone had the lowest incidence rate of PHG(34.8%)and only had mild PHG,and those with gastroesophageal varices had the highest incidence rate of PHG(85.6%).Among the patients without PHG,71(24.2%)were hospitalized due to hematemesis and/or tarry stool,and among the 574 patients with PHG,316(55.1%)were hospitalized,and there was a significant difference between the two groups(χ2=74.562,P<0.05).Conclusion Patients with different severities of PHG have different features of gastric mucosa abnormalities.The development and severity of PHG are closely associated with the severity of gastroesophageal varices and are important causes of gastrointestinal bleeding in liver cirrhosis.PHG should be treated and prevented to reduce the risk and complications of gastrointestinal bleeding.