西藏地区肝硬化门静脉高压食管胃静脉曲张出血的筛查与防治现状:一项多中心研究

来源 :中华肝脏病杂志 | 被引量 : 0次 | 上传用户:shanian
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目的:分析西藏地区肝硬化患者的临床特征,探讨该地区食管胃静脉曲张出血的筛查与防治现状。方法:回顾性收集并分析了2017年3月至2020年2月间西藏地区肝硬化患者的临床资料。结果:研究纳入了511例肝硬化患者,其中代偿性肝硬化185例(36.20%)、失代偿性肝硬化326例(63.80%)。进一步分析肝硬化病因数据显示,慢性乙型肝炎306例(59.88%)、酒精性肝病113例(22.11%)、慢性乙型肝炎合并酒精性肝病68例(13.31%)。在代偿性肝硬化患者中,48例(25.95%)接受过内镜检查,其中33例被诊断有高出血风险静脉曲张。然而,这33例患者均未接受非选择性β受体阻滞剂治疗,仅4例患者接受了内镜套扎治疗。在失代偿性肝硬化患者中,83例(25.46%)有上消化道出血史、297例(91.10%)存在腹水、23例(7.05%)存在肝性脑病、3例(0.92%)存在肝肾综合征。在合并有上消化道出血史的患者中,42例(50.60%)接受过食管胃静脉曲张出血的二级预防治疗,包括内镜治疗39例、内镜联合药物治疗1例、介入治疗3例、外科手术治疗2例。结论:西藏地区肝硬化以慢性乙型肝炎和酒精性肝病为主要病因。该地区对于门静脉高压食管胃静脉曲张出血的筛查、预防及治疗存在不足,需要加大高危人群的筛查、提高首次出血的预防、推进再出血防治的多学科团队协作。“,”Objective:To investigate and analyze the current situation, screening, clinical characteristics, prevention and treatment of bleeding esophageal varices in cirrhotic patients with portal hypertension in Tibet region.Methods:Clinical data of cirrhotic patients with portal hypertension through March 2017 to February 2020 from Tibet region were collected and analyzed retrospectively.Results:511 cases with liver cirrhosis were included in the study, of which 185 cases (36.20%) had compensated cirrhosis and 326 cases (63.80%) had decompensated cirrhosis. Further analysis of the etiological data of liver cirrhosis showed that 306 cases (59.88%) were of chronic hepatitis B, 113 cases (22.11%) of alcoholic liver disease, and 68 cases (13.31%) of chronic hepatitis B combined with alcoholic liver disease. Among patients with compensated liver cirrhosis, 48 cases (25.95%) underwent endoscopic examination of which 33 diagnosed as high-risk variceal bleeding. However, none of these 33 cases had received non-selective β-blocker therapy, and only four patients had received endoscopic variceal banding therapy. Among patients with decompensated liver cirrhosis, 83 cases (25.46%) had a history of upper gastrointestinal bleeding, 297 cases (91.10%) had ascites, 23 cases (7.05%) had hepatic encephalopathy, and 3 cases (0.92%) had hepatorenal syndrome. Among the patients with a history of upper gastrointestinal bleeding, 42 cases (50.60%) had received secondary preventive treatment for bleeding esophageal varices, including 39 cases of endoscopic treatment, 1 case of endoscopic combined drug treatment, 3 cases of interventional treatment, and 2 cases of surgical treatment.Conclusion:Chronic hepatitis B and alcoholic liver diseases are the main causes of liver cirrhosis in Tibet region. Moreover, this region lacks screening, prevention and treatment for bleeding esophageal varices in cirrhotic patients with portal hypertension. Therefore, it is necessary to increase the screening of high-risk groups to prevent and improve the first-time bleeding, and promote multidisciplinary team to prevent and treat re-bleeding.
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