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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
Objective To observe the characteristics of upper gastrointestinal mucosal lesions in patients with chronic severe hepatitis. Methods The patients included in the observation group were divided into two groups: group A was diagnosed as having cirrhosis with portal hypertension and was diagnosed with chronic severe hepatitis, and group B was those with severe hepatitis. Acute jaundice hepatitis patients hospitalized during the same period as a control. Results A total of 68 6% (13 1/191) gastric mucosa of group A had portal hypertensive gastropathy (PHG). The PHG of group B was 246% (43/175) (P <0.05) ). The detection rate of gastric mucosal lesions (GML) in group A was 42 4% (81/191), which was not significantly different from 45 1% (79/175) in group B (P 0 05) There was significant difference between the two groups (P <0.01). Conclusions The occurrence of severe PHG is closely related to liver function. Changes in portal pressure affect gastric mucosal microcirculation, PHG formation has a role. Chronic severe hepatitis GML constitute one of multiple organ dysfunction performance. Its mechanism may be related to clotting factor synthesis disorders; the role of portal hypertension; hypergastrinemia; tumor necrosis factor (TNF) role. One of the many factors may play a leading role at some time. Clinical should pay attention to the overall treatment, such as active supportive therapy, improve liver function, complement coagulation factors, correct hypoxemia, regulate acid-base balance. Gastrointestinal symptoms appear in time for gastroscopy, targeted treatment