【作者】 孙颖；

【导师】 金清龙；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2017， 硕士

【摘要】 目的:门静脉直径可作为反应门脉压力的良好指标,探索与门静脉主干直径相关的实验室指标和临床表现,为门脉压力综合评估寻找更多更可靠的参考证据,指导临床上门脉高压患者诊治。方法:回顾性分析2016年于吉林大学第一临床医院肝胆胰内科住院肝硬化患者409例,(1)排除肝脏、门脉系统占位性病变患者及数据不完善者223例,最终纳入186例患者作为研究对象,分为门静脉直径<1.3cm组;门静脉直径1.3-1.5cm组;门静脉直径>1.5cm组。(2)经CT平扫+增强检查明确诊断为门脉高压伴侧支循环开放者共151例,并根据影像学结果分为伴有脾-肾分流组与不伴有脾-肾分流组。收集患者血清学及影像学资料,通过SPSS软件进行分析,计算出与门脉高压相关的指标。结果:1、门静脉直径分组与CHILD分级构成比之间没有差异性;CHILD分级A级与B级,B级与C级间门静脉直径差异在统计学上有意义(P<0.05),但A级与C级之间无明显差异(P>0.05)。2、血小板、白细胞、GGT、凝血酶时间在不同门静脉直径分级中有明显差异。随着门静脉直径分级加重,血小板、白细胞逐渐减少,凝血酶时间逐渐缩短,GGT逐渐降低。3、血小板计数、白细胞、平均红细胞体积、凝血酶时间、GGT与门静脉直径呈正相关,FIB-4、脾脏指数与门静脉直径呈负相关。4、脾功能亢进和侧支循环开放发生率在门静脉直径分组间具有明显差异(P=0.00,<0.01),肝性脑病、腹腔积液发生率在门静脉直径分组间没有明显差异(P>0.05)。5、分流组腹腔积液、肿瘤的发生率较无分流组明显增加,差异具有统计学意义,(P<0.05),并且分流组女性患者的患病率明显大于无分流组(P=0.03,<0.05)。而消化道出血的发生率差异不明显(P=0.05),肝性脑病、感染、肝掌、蜘蛛痣的发生率在两组间无差异(P>0.05)。结论:1、门脉高压与肝脏功能减退存在相关性,伴随着肝功能逐渐下降,起初门脉高压逐渐加重,但随着肝功能进一步下降,门脉压力反而有所缓解。2、伴随着门脉高压加重,凝血酶时间缩短、GGT下降,有待进一步研究。3、伴随着门脉高压加重,脾脏充血肿大,脾功能亢进加重,白细胞、血小板下降明显,脾功能亢进与侧支循环开放发生率明显增加。更多还原

【Abstract】 Aims:To explore the correlation between portal vein diameter and biochemistry,looking for more reliable reference evidence for the assessment of portal pressure,guiding the diagnosis and treatment of patients with portal hypertension.Methods:409 cases of liver cirrhosis were enrolled in the First Clinical Hospital of Jilin University in 2016.(1)223 patients with liver or portal system occupying lesions and data incomplete were exclusion in this study,and 186 patients were included as the research object.(2)A total of 151 patients with portal hypertension and collateral circulation were diagnosed by CT scan and enhanced examination.According to the imaging results,the patients was divided into two groups:with or without spleno-renal shunt.The serological and imaging data were collected and analyzed by SPSS software to calculate the indexes related to portal hypertension.Results:1.There was no difference in the ratio of portal vein diameter to CHILD classification.(P <0.05),There was statistically significant between grade A and grade B,grade B and grade C(P <0.05),but there was no significant difference between grade A and grade C(P> 0.05).2.Platelet,white blood cell,GGT,thrombin time in different portal vein diameter classification was significantly different.With the portal vein diameter grading,platelets,white blood cells gradually reduced,thrombin time gradually shortened,GGT gradually reduced.3.There was a positive correlation between platelet count,white blood cell,mean red blood cell volume,thrombin time,GGT and portal vein diameter,FIB-4,spleen index and portal vein diameter were negatively correlated.4.The incidence of hyperthyroidism and collateral circulation was significantly different between portal vein diameter groups(P = 0.00,<0.01).There was no significant difference in the incidence of hepatic encephalopathy and peritoneal effusion between portal vein diameter groups(P> 0.05).5.The prevalence of peritoneal effusion and the incidence of tumor in the shunt group was significantly higher than that in the non-shunt group(P <0.05),and the prevalence of female patients in the shunt group was significantly greater than that without the shunt group(P=0.03,<0.05).There was no significant difference in the incidence of hepatic encephalopathy,infection,liver palms and spider nevus between the two groups(P> 0.05).Conclusions:1.There is correlation between portal hypertension and liver function.with the gradual decline in liver function,the first portal hypertension gradually increased,but with further decline in liver function,portal pressure but alleviated.2.With the increase of portal hypertension,thrombin time is shortened,GGT decreased,pending further study.3.Accompanied by increased portal hypertension,spleen congestion and enlargement,increased spleen hyperthyroidism,white blood cells,platelets decreased significantly,hyperthyroidism and collateral circulation increased significantly the incidence of circulation.更多还原