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目的:比较病毒性肝硬化与特发性门脉高压症患者在腹腔积液的发生率、临床指标及预后之间的差异,探讨腹腔积液与肝硬化及门脉高压症临床预后之间的关系。方法:采用回顾性的研究方法收集150例肝硬化患者的临床资料,其中包括病毒性肝炎肝硬化138例,特发性门静脉高压患者12例,比较二者各项临床资料之间的差异,并对3年内的生存率进行随访。结果:出现腹腔积液的患者中,曲张静脉破裂出血、门静脉血栓形成在特发性门脉高压患者中更多见。病毒性肝硬化患者中出现腹腔积液的患者Child-Pugh分级、终末期肝病评分、胆红素肠系膜下静脉曲张发生率均较无腹腔积液组患者更高,白蛋白水平和凝血酶原活动度百分比降低。两组患者在总生存率之间没有显著差异,病毒性肝硬化组1年为85.2%,3年74.6%;特发性门脉高压患者1年100%,3年91.8%。出现腹腔积液的患者生存率病毒性肝硬化组为1年67.1%,3年42.5%;特发性门脉高压组患者3年内无患者发生死亡。病毒性在肝硬化组患者中无腹腔积液者1年生存率为95.1%、3年92.5%,少量腹腔积液为1年78.3%、3年53.2%,中等量以上腹水为1年53.6%、3年23.3%;特发性门脉高压患者3年未出现死亡病例。结论:病毒性肝硬化和特发性门静脉高压患者之间在总的生存率之间未见差异,但对于合并腹腔积液的患者病毒性肝硬化患者生存率更低、预后更差,在病毒性肝硬化和特发性门静脉高压患者中是否出现腹腔积液与生存率及预后密切相关。
OBJECTIVE: To compare the differences in the incidence of ascites, clinical features and prognosis among patients with viral cirrhosis and idiopathic portal hypertension and to explore the relationship between ascites and clinical outcomes of cirrhosis and portal hypertension relationship. Methods: A retrospective study was conducted to collect clinical data of 150 patients with cirrhosis, including 138 patients with viral hepatitis and cirrhosis and 12 patients with idiopathic portal hypertension. The differences between the two clinical data were compared and analyzed. The 3-year survival rate was followed up. Results: In patients with ascites, variceal bleeding and portal vein thrombosis were more common in patients with idiopathic portal hypertension. Child-Pugh grading, end-stage liver disease score, and incidence of bilirubin mesenteric varices in patients with ascites were significantly higher in patients with viral cirrhosis than those without ascites, and albumin levels and prothrombin activity Percentage reduction. There was no significant difference in overall survival between the two groups, with 85.2% in one year and 74.6% in three years in patients with viral cirrhosis; 100% in patients with idiopathic portal hypertension and 91.8% in three years. The survival rate of patients with ascites was 67.1% in viral liver cirrhosis and 42.5% in 3 years. No patient died in idiopathic portal hypertension within 3 years. 1 year survival rate was 95.1% at 3 years, a small amount of ascites was 78.3% at 1 year and 53.2% at 3 years. The average amount of ascites was 53.6% at 1 year in patients with cirrhosis, , 3 years 23.3%; idiopathic portal hypertension patients did not appear to die in 3 years. CONCLUSIONS: There was no difference in overall survival between patients with viral cirrhosis and idiopathic portal hypertension, but patients with viral cirrhosis had lower survival and poorer prognosis in patients with ascites, Whether or not patients with idiopathic cirrhosis and idiopathic portal hypertension appear to be closely related to the survival rate and prognosis of patients with ascites.