肝硬化患者门静脉高压性胃病发病因素的研究

背景：门静脉高压性胃病是肝硬化患者上消化道出血的原因之一．但其发病机制目前尚不完全清楚。目的：探讨肝硬化患者门静脉高压性胃病的发生与肝硬化分级、食管胃底静脉曲张程度、腹水量和胃肠激素血管活性肠肽（VIP）水平的关系。方法：45例肝硬化患者行胃镜检查观察食管胃底静脉曲张程度和胃黏膜改变．行腹部B超检查观察腹水量，同时检测血清白蛋白、总胆红素、胆碱酯酶、凝血酶原时间等肝功能指标和血浆VIP水平。结果：Child—Pugh A、B、C级肝硬化患者、不同程度食管胃底静脉曲张患者以及不同程度腹水患者之间的门静脉高压性胃病发生率均无显著差异（P〉0．05）。但肝硬化伴门静脉高压性胃病患者的血浆VIP水平较无门静脉高压性胃病者显著升高（P〈0．001）。结论：门静脉高压是门静脉高压性胃病的必要条件，而其他因素．如血浆VIP水平与门静脉高压性胃病的发生也有一定关系。

Factors Influencing the Development of Portal Hypertensive Gastropathy in Cirrhotic Patients

Background: Portal hypertensive gastropathy is one of the causes of upper gastrointestinal bleeding in cirrhotic patients, but its pathogenesis still remains uncertain. Aims: To investigate the correlations of portal hypertensive gastropathy with the grade of cirrhosis, gastroesophageal varices, ascites and the level of vasoactive intestinal peptide (VIP) in cirrhotic patients. Methods: Forty-five patients with liver cirrhosis were enrolled in this study. Gastroesophageal varices and the changes of gastric mucosa were examined by upper gastrointestinal endoscopy. Ultrasonography was used to evaluate the amount of ascites. Serum albumin, total bilirubin, cholinesterase, prothrombin time and plasma VIP level were determined simultaneously. Results: The incidence of portal hypertensive gastropathy among cirrhotic patients in Child-Pugh A, B and C was not significantly different (P>0.05). Also, no significant correlations were found between portal hypertensive gastropathy and the severity of gastroesophageal varices, and the amount of ascites (P>0.05). However, the plasma level of VIP was significantly higher in cirrhotic patients with portal hypertensive gastropathy than that in those without (P<0.001). Conclusions: Although portal hypertension is prerequisite in the pathogenesis of portal hypertensive gastropathy, there may be other factors such as plasma VIP level that can influence the development of portal hypertensive gastropathy as well.