83例肝源性溃疡的临床病例分析(1)
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【摘要】 目的 研究肝源性溃疡的发病情况、发生机理和临床特点。方法 对312例肝硬化患者行胃镜检查,并收集临床资料,采用尿素酶和14C呼气实验方法检测幽门螺杆菌。结果 肝硬化的诊断是通过临床表现、超声、CT和生化检查等综合作出的。312例患者中检出消化性溃疡83例,占26.6%。将312例肝硬化分为Child-Pugh A、B和C 3级,消化性溃疡的检出率分别为10.1%、22.6%和35.0%,经统计学处理,各组间消化性溃疡的检出率均有显著差别(p<0.05);将312例患者按食道静脉曲张的程度分为Ⅰ度69例、Ⅱ度102例和Ⅲ度141例,各组消化性溃疡的检出率分别为10.1%、24.5%和36.1%,经统计学处理,各组间的检出率均有显著差别(p<0.05);幽门螺杆菌感染组消化性溃疡的检出率为显著高于非溃疡病组(p< 0.05)。结论 肝硬化患者消化性溃疡的发生率明显增加,其发生机制可能与肝硬化门脉高压所致胃肠淤血有关。
【关键词】消化性溃疡肝硬化
中国分类号:R573文献标识号:A 文章编号:1005-0515(2010)10-071-03
【Abstract】Objective We investigated the prevalence,pathogenesis and clinical characteristics of peptic ulcer in patiants with liver cirrhosis. METHODS The iagnosis of cirrhosis was confirmed by a combination of clinical, radiological, and biochemical methods.Upper gastrointestinal endoscopy was performed in 312 patients with liver cirrhosis consecutively to evaluate the pre sence of varice s and gastroduode nal mucosa. H. pylori status was assessed by rapid urease test and 14C-urea breath test. RESULTS Out of 312 consecutive cirrhotic patients who underwent endoscopy, 83 had peptic ulcer,the prevalence of peptic ulcer disease in these patients was 26.6%. The prevalence of peptic ulcer disease in patients with cirrhosis divided into Child-Pugh classes A, B, and C was10.1%, 22.6%, and 35.0%, respectively (p<0.05). Gastroscopy identified esophageal varices in 312 patients,which were grade I in 69 patients, grade II in 102,and grade Ⅲ in 141,prevalence of peptic ulcer disease was 10.1% in grade I,24.5% in grade II and 36.1% in grade Ⅲ,respectively (p<0.05). The prevalence of peptic ulcer in H. pylori+ was significantly higher than in H. pylori+ patients with cirrhotics (p<0.05). CONCLUSIONS The prevalence of peptic ulcer was increased in cirrhotic patients and H. pylori infection,Child-Pugh classes,esophageal varices may be involved in the pathogenesis of peptic ulcer disease in the setting of liver cirrhosis.
【Key Word】peptic ulcer liver cirrhosis
肝硬化患者消化性溃疡在的发生率显著高于正常人群,但其发生的机制尚未完全阐明[1,2]。肝硬化合并消化性溃疡被称为肝源性溃疡(hepatogenic ulcer,HU),是肝硬化患者上消化道出血的常见原因之一。由于溃疡症状不典型,缺乏特异性,易被肝硬化的症状所掩盖,以致漏诊率较高, 延误治疗。为提高HU 的临床诊疗水平,我们收集了2002年～2007年我科收治的曾行胃镜检查的312例肝炎后肝硬化患者的临床病理资料,其中83例存在HU,结合文献对其发病机理和临床特点进行了分析 ......
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