慢性重型肝炎伴胃粘膜病变及门脉高压性胃病的研究

目的　观察慢性重型肝炎患者上消化道粘膜病变特点。方法　将列入观察对象的患者分为 2个组 :A组为肝硬化伴门静脉高压转重而符合慢性重型肝炎诊断者 ;B组为慢性肝炎病情转重者。同期住院的急性黄疸型肝炎病人作为对照观察。结果　A组慢重肝患者有 68 6% ( 13 1/ 191)胃体粘膜出现门脉高压性胃病 (PHG)改变 ;B组PHG为 2 4 6% ( 43 / 175 ) (P <0 0 5 ) ;A组胃粘膜病变 (GML)的检出率为 42 4% ( 81/ 191) ,与B组的45 1% ( 79/ 175 )无明显差异 (P >0 0 5 ) ;但与对照组相比差异显著 (P <0 0 1)。结论　重度PHG的发生与肝脏功能密切相关。门脉压变化影响胃粘膜微循环 ,对PHG形成有一定作用。慢性重型肝炎发生GML构成多脏器功能损伤表现之一。其发生机制可能与凝血因子合成障碍 ;门脉高压的作用 ;高胃泌素血症 ;肿瘤坏死因子(TNF)的作用有关。多种因素中某一因素可能在某一时期起主导作用。临床应重视整体治疗 ,如积极的支持疗法 ,改善肝功 ,补充凝血因子 ,纠正低氧血症 ,调节酸硷平衡。出现消化道症状及时进行胃镜检查 ,针对性处理

Study of gastric mucosal lesion and portal hypertensive gastropathy in patients with chronic severe hepatitis

Objective To observe features of the gastric mucosa in patients with chronic severe hepatitis by endoscopy.Method 366 patients with chronic severe hepatitis were divided into two groups.Group A:cirrhosis patients accompanied by portal hypertension aggravated to chronic severe hepatitis;Group B:chronic hepatitis aggravated to chronic severe hepatitis.Make comparisons with acute jaundiced hepatitis during the same period.Result Group A:portal hypertensive gastropathy(PHG) was observed in 131 cases(68.6%),and acute gastric mucosal lesion(AGML) was 42.4%(81/191);Group B:PHG was 24.6%(43/175),and AGML was 45.1%(79/175).Conclusion The mucosa damage of upper digestive tract with chronic severe hepatitis is one the manifestations of multiple organ function failure.It may be concerned with the decrease of coagulation factors for the disorder of liver function,hypoproteinemia,portal hypertension,hypergastrinemia,tumor necrosis factor(TNF).One of the facts may become the main factor in a certain period of time.Therefore, once there is the digestive tract symptom,we should make the gastroscopy for right-to-the-point treatment.