CAJ | 학술논문

目的：探讨原发性胆汁性肝硬化（PBC）患者出现食管胃静脉曲张的危险因素指标。方法纳入2008年1月至2014年11月的 PBC 并行胃镜检查患者112例，其中行肝活组织穿刺检查24例。分析患者组织学分期、年龄、性别、抗着丝点抗体、PLT 、白蛋白、TBil 、ALP 、GGT 、AST 、ALT 、PT 、Mayo 评分与食管胃静脉曲张的相关性，通过多因素非条件 Logistic 回归，筛选出可能有效独立预测PBC 出现食管胃静脉曲张的危险因素。结果112例 PBC 患者中，静脉曲张62例，其中单纯食管静脉曲张51例，食管胃静脉曲张9例，单纯胃静脉曲张占2例。肝组织穿刺检查的24例患者中，15例有静脉曲张，其中2例发生在组织学早期（Ⅰ和Ⅱ期），13例发生在组织学晚期（Ⅲ和Ⅳ期）。静脉曲张患者抗着丝点抗体阳性、PT 、TBil 和 Mayo 评分高于无曲张患者，而白蛋白、GGT 、PLT 水平低于无曲张患者，差异均有统计学意义（P 均＜0．01）。多因素非条件 Logistic 回归结果显示，抗着丝点抗体阳性（OR ＝8．759，95％ CI ：1．308～58．637）、Mayo 评分≥4．52（OR ＝8．941，95％ CI ：1．145～69．809）、PLT ＜96．5×109／L （OR ＝10．410，95％ CI ：2．344～46．224）和 TBil ＞26．62μmol／L （OR ＝14．348，95％ CI ：2．945～69．913）为食管胃静脉曲张独立的危险因素。结论抗着丝点抗体阳性、PLT 计数＜96．5×109／L 、TBil ＞26．62μmol／L和 Mayo 评分≥4．52有助于预测 PBC 患者出现食管胃静脉曲张。
목적：탐토원발성담즙성간경화（PBC）환자출현식관위정맥곡장적위험인소지표。방법납입2008년1월지2014년11월적 PBC 병행위경검사환자112례，기중행간활조직천자검사24례。분석환자조직학분기、년령、성별、항착사점항체、PLT 、백단백、TBil 、ALP 、GGT 、AST 、ALT 、PT 、Mayo 평분여식관위정맥곡장적상관성，통과다인소비조건 Logistic 회귀，사선출가능유효독립예측PBC 출현식관위정맥곡장적위험인소。결과112례 PBC 환자중，정맥곡장62례，기중단순식관정맥곡장51례，식관위정맥곡장9례，단순위정맥곡장점2례。간조직천자검사적24례환자중，15례유정맥곡장，기중2례발생재조직학조기（Ⅰ화Ⅱ기），13례발생재조직학만기（Ⅲ화Ⅳ기）。정맥곡장환자항착사점항체양성、PT 、TBil 화 Mayo 평분고우무곡장환자，이백단백、GGT 、PLT 수평저우무곡장환자，차이균유통계학의의（P 균＜0．01）。다인소비조건 Logistic 회귀결과현시，항착사점항체양성（OR ＝8．759，95％ CI ：1．308～58．637）、Mayo 평분≥4．52（OR ＝8．941，95％ CI ：1．145～69．809）、PLT ＜96．5×109／L （OR ＝10．410，95％ CI ：2．344～46．224）화 TBil ＞26．62μmol／L （OR ＝14．348，95％ CI ：2．945～69．913）위식관위정맥곡장독립적위험인소。결론항착사점항체양성、PLT 계수＜96．5×109／L 、TBil ＞26．62μmol／L화 Mayo 평분≥4．52유조우예측 PBC 환자출현식관위정맥곡장。
Objective To explore the risk factors of esophageal gastric varices in patients with primary biliary cirrhosis (PBC ) .Methods From January 2008 to November 2014 ,112 PBC patients underwent gastroscopy examination and among them 24 received liver biopsy .The correlation between esophageal gastric varices and histological stage ,age ,gender ,anti‐centromere antibodies (ACA) ,platelet (PLT ) , albumin (Alb ) , total bilirubin (TBil ) , alkaline phosphatase (ALP ) , γ‐glutamyl‐transferase (GGT ) ,aspartate‐aminotransferase (AST ) ,alanine‐aminotransferase (ALT ) ,prothrombin time (PT ) and Mayo score was analyzed .Logistic regression analysis was used to identify independent risk factors predicting esophageal gastric varices in PBC patients .Results Among 112 patients with PBC ,varices was found in 62 patients (51 pure esophageal varices ,nine esophageal gastric varices and two pure gastric varices) .Among 24 patients with liver biopsy ,15 had varices (two at early histological stage Ⅰ and Ⅱ , 13 at later histological stage Ⅲ and Ⅳ ) .The ACA positive rate ,PT ,TBil and Mayo score of patients with varices were higher than those of patients without varices ;while Alb ,GGT and PLT were lower than those of patients without varices , and the differences were statistically significant (all P < 0 .01) . Multivariate Logistic regression analysis revealed that positive ACA (odds ratio (OR) = 8 .759 ,95%cofidence interval (CI) :1 .308 to 58 .637) ,Mayo score over 4 .52 (OR = 8 .941 ,95% CI :1 .145 to 69 .809) ,PLT count less than 96 .5 × 109 /L (OR = 10 .410 ,95% CI :2 .344 to 46 .224) ,TBil level over 26 .62 μmol/L(OR = 14 .348 ,95% CI :2 .945 to 69 .913) were independent risk factors predicting varices . Conclusion ACA positive ,PLT count less than 96 .5 × 109 /L ,TBil level over 26 .62 μmol/L and Mayo score over 4 .52 can help to predict esophageal gastric varices in patients with PBC .