30岁以下人群食管胃静脉曲张患者临床特点分析

doi:10.3969/j.issn.1672-5069.2022.04.024

摘要/Abstract

摘要： 目的分析总结30岁以下食管胃静脉曲张(GOV)患者的临床特点。方法 2015年1月～2020年12月解放军总医院第一医学中心消化内科医学部收治的61例30岁以下GOV患者,提取、分析和总结其临床资料。结果在61例GOV患者中,肝硬化门静脉高压症27例(44.3%),其中隐源性肝硬化占40.7%,乙型肝炎肝硬化占33.3%,和非肝硬化性门静脉高压(NCPH)34例(55.7%),其中以门静脉海绵样变占61.8%;基于内镜下静脉曲张LDRf分型,在位置方面主要以Le/g型多见(77.1%),在直径方面,D1.0占41.0%,在出血风险方面,Rf1分级占77.1%;针对GOV治疗,以二级预防治疗为主(85.7%),多采用组织胶或硬化剂注射或套扎联合治疗(66.1%);NCPH患者GOV再出血比例为11.8%,显著低于肝硬化组的29.6%(P＜0.01)。结论 30岁以下人群GOV患者以NCPH居多,其中以各种原因引起的门脉海绵样变最多见。NCPH患者并发GOV经内镜治疗后再出血发生率显著低于肝硬化患者。

关键词: 肝硬化, 非肝硬化性门脉高压, 门脉高压症, 食管胃静脉曲张

Abstract: Objective The aim of this study was to summarize the clinical features of patients with portal hypertension and gastroesophageal varices (GOV) under 30 year old of age.Methods The clinical data of 61 inpatients with GOV aged under 30 year old encountered between January 2015 and December 2020 were retrospectively summarized. Results Out of the 61 patients with GOV, the cirrhotic portal hypertension were found in 27 patients (44.3%), including cryptogenic cirrhosis in 11 patients (40.7%), and hepatitis B cirrhosis in 9 patients (33.3%), and noncirrhotic portal hypertension (NCPH) were found in 34 cases (55.7%), including cavernous transformation of portal vein in 21 patients (61.8%); as for the LDRf classification, the varices in our series were mainly Le/ g type, accounting for 77.1%, in terms of diameter, D1.0 for 41.0%, and in terms of bleeding risk factor, the Rf grade 1 were more common (77.1%); the secondary prevention was the main treatment (85.7%), and tissue glue and sclerosing agent injection or band ligation combination was commonly administered (66.1%) in our series; the incidence of rebleeding in patient with NCPH was 11.8%, significantly lower than 29.6% in patients with liver cirrhosis (P＜0.01). Conclusion The majority of young patients with GOV have portal hypertension caused by non-cirrhotic factors, and portal cavernous transformation is the main cause of NCPH. The rebleeding of esophageal and gastric varices in patients with NCPH is relatively lower than that in patients with liver cirrhosis.

Key words: Liver cirrhosis, Non-cirrhotic portal hypertension, Portal hypertension, Gastroesophageal varices

何薇, 张晓彬, 刘迎娣, 何占娣. 30岁以下人群食管胃静脉曲张患者临床特点分析[J]. 实用肝脏病杂志, 2022, 25(4): 550-553.

He Wei, Zhang Xiaobin, Liu Yingdi, et al. Clinical features of patients with gastroesophageal varices under 30 years old[J]. Journal of Practical Hepatology, 2022, 25(4): 550-553.

参考文献

[1] Rockey DC, Elliott A, Lyles T. Prediction of esophageal varices and variceal hemorrhage in patients with acute upper gastrointestinal bleeding. J Investig Med, 2016, 64(3):745-751.
[2] 何福亮, 马琳, 李悦榕, 等. 非肝硬化性门脉高压的临床诊断. 实用肝脏病杂志, 2022, 25(1):1-4.
[3] 王晓霞, 邹正升, 李保森, 等. 2002至2011年中国“北方”地区住院肝硬化患者病因构成及变化趋势分析. 实用肝脏病杂志, 2014, 17(2):154-158.
[4] 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南. 实用肝脏病杂志, 2016, 19(5):641-656.
[5] Nukala K, Srinivasan VR, Sagar RV. Clinical presentation of cases with upper gastrointestinal bleeding. J Assoc Physicians India, 2022, 70(4):11-12.
[6] Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology, 2017, 65(1):310-335.
[7] Li M, Wang ZQ, Zhang L, et al. Burden of cirrhosis and other chronic liver diseases caused by specific etiologies in China, 1990-2016: findings from the global burden of disease study 2016. Biomed Environ Sci, 2020, 33(1):1-10.
[8] McMahon BJ. The natural history of chronic hepatitis B virus infection. Hepatology, 2009, 49(5):S45-S55.
[9] Li YY, Zhang Z, Shi JF, et al. Risk factors for naturally-occurring early-onset hepatocellular carcinoma in patients with HBV-associated liver cirrhosis in China. Int J Clin Exp Med, 2015, 8(1):1205-1212.
[10] Wang FS, Fan JG, Zhang Z, et al. The global burden of liver disease: the major impact of China. Hepatology, 2014, 60(6):2099-2108.
[11] Schwimmer JB, Zepeda A, Newton KP, et al. Longitudinal assessment of high blood pressure in children with nonalcoholic fatty liver disease. Plos One, 2014, 9(11): e112569.
[12] Kang JH, Matsui T. Changing etiology in liver cirrhosis in Sapporo, Japan. Euroasian J Hepatogastroenterol, 2018, 8(1):77-80.
[13] Da BL, Koh C, Heller T. Noncirrhotic portal hypertension. Curr Opin Gastroenterol, 2018, 34(3):140-145.
[14] Siramolpiwat S, Seijo S, Miquel R, et al. Idiopathic portal hypertension: natural history and long-term outcome. Hepatology, 2014, 59(6):2276-2285.
[15] 牛会林, 高秋, 王凤华, 等. 64例儿童门静脉高压肝脏病理学分析. 中华病理学杂志, 2020, 49(1):68-71.
[16] 中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019年版). 中华消化外科杂志, 2019, 18(12):1087-1093.
[17] Noronha Ferreira C, Seijo S, Plessier A, et al. Natural history and management of esophagogastric varices in chronic noncirrhotic, nontumoral portal vein thrombosis. Hepatology, 2016, 63(5):1640-1650.
[18] Khanna R, Sarin SK. Idiopathic portal hypertension and extrahepatic portal venous obstruction. Hepatol Int, 2018, 12(1):148-167.
[19] Etzion O, Koh C, Heller T. Noncirrhotic portal hypertension: An overview. Clin Liver Dis, 2015, 6(3):72-74.
[20] Sahin A, Artas H, Tunc N, et al. Hematological indices in portal hypertension: cirrhosis versus noncirrhotic portal hypertension. J Clin Med, 2018, 7(8):196.