摘要
目的探讨乙肝肝硬化(LC-B)患者合并食管胃静脉曲张出血(EVB)风险与糖代谢紊乱的相关性。方法选取2014年9月—2022年8月合肥医科大学附属医院及遂宁市中心医院收治的完成胃镜检查及口服葡萄糖耐量试验(OGTT)检查的146例LC-B患者作为研究对象,其中糖代谢正常(NGT)患者50例(34.2%),糖耐量受损(IGT)患者53例(36.3%),肝源性糖尿病(HD)患者43例(29.5%)。据胃镜检查报告中食管胃静脉曲张程度分为合并高危静脉曲张(HRVs)患者50例(34.2%),未合并HRVs患者96例(65.8%)。HRVs包括中、重度静脉曲张或有红色征的小静脉曲张,分析HRVs与糖代谢紊乱的相关性。结果合并HRVs肝硬化患者凝血酶原活动度(PTA)、白细胞(WBC)、血红蛋白(HGB)、血小板(PLT)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、谷氨酰转移酶(GGT)、胆碱酯酶(CHE)、白蛋白(ALB)、前白蛋白(PA)水平显著低于未合并HRVs肝硬化患者,凝血酶原时间(PT)、国际标准化比值(INR)、AST/ALT、总胆汁酸(TBA)、肝纤维化4因子指数(FIB-4)、Child-pugh评分、终末期肝病模型(MELD)评分、肝硬度(LSM)及门静脉内径宽度显著高于未合并HRVs肝硬化患者,差异具有统计学意义(P<0.05)。43例合并HD患者中22例(51.2%)合并HRVs,显著高于NGT患者(24%)(P=0.009),但与IGT患者(30.2%)比较差异无统计学意义(P>0.05),IGT组与NGT组(24%)比较,HRVs也无显著差异(P>0.05)。合并HRVs肝硬化患者HD发生率(44.0%)也显著高于未合并HRVs患者(21.9%)(P<0.05)。结论LC-B患者HRVs的发生与肝脏损伤程度及糖代谢紊乱程度相关,合并HD的肝硬化患者HRVs发病率显著升高,合并HRVs的患者HD发病率也明显增加。
Objective To analyze the correlation between the risk of esophagogastric varices bleeding(EVB)and glucose metabolism disorders in patients with hepatitis B virus related liver cirrhosis(LC-B).Methods A total of 146 patients with LC-B admitted to the Affiliated Hospital of Zunyi Medical University and Suining Central Hospital from September 2014 to August 2022,who completed gastroscopy and oral glucose tolerance test(OGTT)examinations,were selected as the study subjects.According to the extent of esophagogastric varices in the gastroscopy,high-risk varices(HRVs)were determined.“HRVs”were defined as medium/large varices or small varices with red wale marks.The correlation between HRVs and glucose metabolism disorders was analyzed.Results The study include 146 patients with LC-B according to the inclusion criteria.Among them,there were 50 patients(34.2%)with HRVs and 96 patients(65.8%)without HRVs.There were 50 patients with normal glucose tolerance(NGT)(34.2%),53 patients with impaired glucose tolerance(IGT)(36.3%),and 43 patients with hepatogenous diabetes(HD)(29.5%).The levels of prothrombin activity,leukocytes,hemoglobin,platelets,alanine aminotransferase(ALT),cholinesterase,albumin,aspartate aminotransferase(AST),glutamyltransferase,and prealbumin in patients with HRVs were significantly lower than those in patients without HRVs(P<0.05).The prothrombin time,AST/ALT,total bile acid,liver fibrosis factor 4 index,Child-Pugh score,end-stage liver disease score,liver stiffness measurement,and portal vein diameter in patients with HRVs were significantly higher than those in patients without HRVs(P<0.05).22(51.2%)of 43 patients with HD were associated with HRVs,which was significantly higher than that in patients with NGT(24%)(P=0.009),but there was no statistical difference when compared with that inpatients with IGT(30.2%)(P>0.05),and there was no significant difference in HRVs prevalence between the patients with IGT and NGT(P>0.05).The incidence of HD in patients with HRVs was also significantly higher than that in patients without HRVs.Conclusion The occurrence of high-risk varices in patients with LC-B is related to the degree of liver injury and the degree of glucose metabolism disorders.The incidence of high-risk varices in patients with HD is significantly higher than that in patients with NGT,and the incidence rate of HD in patients with high-risk varices is also significantly higher than that in patients without high-risk varices.
作者
谭敏
舒丽
周红
梅丽华
李毅
林世德
TAN Min;SHU Li;ZHOU Hong;MEI Lihua;LI Yi;LIN Shide(Suining Central Hospital,Suining 629000,Sichuan,China;The Affiliated Hospital of Zunyi Medical University,Zunyi 563003,Guizhou,China)
出处
《西部医学》
2025年第7期1031-1036,1041,共7页
Medical Journal of West China
基金
国家自然科学基金项目(81860114)。
关键词
肝硬化
肝源性糖尿病
食管胃静脉曲张
肝脏硬度测量
高危静脉曲张
Liver cirrhosis
Hepatogenous diabetes
Esophagogastric varices
Liver stiffness measurement
High-risk varices
