CAJ | 학술논문

目的：利用瞬时弹性成像技术测量慢性肝病肝硬化患者肝硬度值及脾硬度值，评估不同 Child - Pugh分级、食管胃底静脉曲张程度、出血情况慢性肝病肝硬化患者肝硬度值及脾硬度值的差异。方法选取2011年4月—2014年12月天津市第三中心医院住院的所有接受电子胃镜检查的慢性肝病肝硬化患者340例为研究对象，其中慢性乙型肝炎肝硬化患者170例，慢性丙型肝炎肝硬化患者35例，原发性胆汁性肝硬化患者46例，酒精性肝病肝硬化患者55例，自身免疫性肝炎肝硬化患者34例，分别检测血常规、凝血常规、肝功能、电子胃镜检查、腹部彩色多普勒超声以及进行瞬时弹性成像技术检查测量肝硬度值及脾硬度值。比较不同 Child - Pugh 分级、食管胃底静脉曲张程度、出血情况慢性肝病肝硬化患者肝硬度值及脾硬度值的差异。结果 Child - Pugh B 级、Child - Pugh C 级慢性乙型肝炎肝硬化、慢性丙型肝炎肝硬化、原发性胆汁性肝硬化、酒精性肝病肝硬化、自身免疫性肝炎肝硬化患者肝硬度值及脾硬度值高于 Child - Pugh A 级患者（P ＜0.05）；Child - Pugh C 级各型慢性肝病肝硬化患者肝硬度值及脾硬度值高于 Child -Pugh B 级患者（P ＜0.05）。轻度静脉曲张、中度静脉曲张、重度静脉曲张各型慢性肝病肝硬化患者肝硬度值及脾硬度值高于无静脉曲张患者（P ＜0.05）；中度静脉曲张、重度静脉曲张各型慢性肝病肝硬化患者肝硬度值及脾硬度值高于轻度静脉曲张患者（P ＜0.05）；重度静脉曲张各型慢性肝病肝硬化患者肝硬度值及脾硬度值高于中度静脉曲张患者（P ＜0.05）。单次出血、反复多次出血各型慢性肝病肝硬化患者肝硬度值及脾硬度值高于无出血患者（P ＜0.05）；反复多次出血各型慢性肝病肝硬化患者肝硬度值及脾硬度值高于单次出血患者（ P ＜0.05）。结论 Child - Pugh 分级越高、食管胃底静脉曲张程度越重、出血情况越重慢性肝病肝硬化患者肝硬度值及脾硬度值越高；瞬时弹性成像技术可以有效地预测慢性肝病肝硬化患者肝硬化程度、食管胃底静脉曲张破裂出血的风险。目的：利用瞬時彈性成像技術測量慢性肝病肝硬化患者肝硬度值及脾硬度值，評估不同 Child - Pugh分級、食管胃底靜脈麯張程度、齣血情況慢性肝病肝硬化患者肝硬度值及脾硬度值的差異。方法選取2011年4月—2014年12月天津市第三中心醫院住院的所有接受電子胃鏡檢查的慢性肝病肝硬化患者340例為研究對象，其中慢性乙型肝炎肝硬化患者170例，慢性丙型肝炎肝硬化患者35例，原髮性膽汁性肝硬化患者46例，酒精性肝病肝硬化患者55例，自身免疫性肝炎肝硬化患者34例，分彆檢測血常規、凝血常規、肝功能、電子胃鏡檢查、腹部綵色多普勒超聲以及進行瞬時彈性成像技術檢查測量肝硬度值及脾硬度值。比較不同 Child - Pugh 分級、食管胃底靜脈麯張程度、齣血情況慢性肝病肝硬化患者肝硬度值及脾硬度值的差異。結果 Child - Pugh B 級、Child - Pugh C 級慢性乙型肝炎肝硬化、慢性丙型肝炎肝硬化、原髮性膽汁性肝硬化、酒精性肝病肝硬化、自身免疫性肝炎肝硬化患者肝硬度值及脾硬度值高于 Child - Pugh A 級患者（P ＜0.05）；Child - Pugh C 級各型慢性肝病肝硬化患者肝硬度值及脾硬度值高于 Child -Pugh B 級患者（P ＜0.05）。輕度靜脈麯張、中度靜脈麯張、重度靜脈麯張各型慢性肝病肝硬化患者肝硬度值及脾硬度值高于無靜脈麯張患者（P ＜0.05）；中度靜脈麯張、重度靜脈麯張各型慢性肝病肝硬化患者肝硬度值及脾硬度值高于輕度靜脈麯張患者（P ＜0.05）；重度靜脈麯張各型慢性肝病肝硬化患者肝硬度值及脾硬度值高于中度靜脈麯張患者（P ＜0.05）。單次齣血、反複多次齣血各型慢性肝病肝硬化患者肝硬度值及脾硬度值高于無齣血患者（P ＜0.05）；反複多次齣血各型慢性肝病肝硬化患者肝硬度值及脾硬度值高于單次齣血患者（ P ＜0.05）。結論 Child - Pugh 分級越高、食管胃底靜脈麯張程度越重、齣血情況越重慢性肝病肝硬化患者肝硬度值及脾硬度值越高；瞬時彈性成像技術可以有效地預測慢性肝病肝硬化患者肝硬化程度、食管胃底靜脈麯張破裂齣血的風險。
목적：이용순시탄성성상기술측량만성간병간경화환자간경도치급비경도치，평고불동 Child - Pugh분급、식관위저정맥곡장정도、출혈정황만성간병간경화환자간경도치급비경도치적차이。방법선취2011년4월—2014년12월천진시제삼중심의원주원적소유접수전자위경검사적만성간병간경화환자340례위연구대상，기중만성을형간염간경화환자170례，만성병형간염간경화환자35례，원발성담즙성간경화환자46례，주정성간병간경화환자55례，자신면역성간염간경화환자34례，분별검측혈상규、응혈상규、간공능、전자위경검사、복부채색다보륵초성이급진행순시탄성성상기술검사측량간경도치급비경도치。비교불동 Child - Pugh 분급、식관위저정맥곡장정도、출혈정황만성간병간경화환자간경도치급비경도치적차이。결과 Child - Pugh B 급、Child - Pugh C 급만성을형간염간경화、만성병형간염간경화、원발성담즙성간경화、주정성간병간경화、자신면역성간염간경화환자간경도치급비경도치고우 Child - Pugh A 급환자（P ＜0.05）；Child - Pugh C 급각형만성간병간경화환자간경도치급비경도치고우 Child -Pugh B 급환자（P ＜0.05）。경도정맥곡장、중도정맥곡장、중도정맥곡장각형만성간병간경화환자간경도치급비경도치고우무정맥곡장환자（P ＜0.05）；중도정맥곡장、중도정맥곡장각형만성간병간경화환자간경도치급비경도치고우경도정맥곡장환자（P ＜0.05）；중도정맥곡장각형만성간병간경화환자간경도치급비경도치고우중도정맥곡장환자（P ＜0.05）。단차출혈、반복다차출혈각형만성간병간경화환자간경도치급비경도치고우무출혈환자（P ＜0.05）；반복다차출혈각형만성간병간경화환자간경도치급비경도치고우단차출혈환자（ P ＜0.05）。결론 Child - Pugh 분급월고、식관위저정맥곡장정도월중、출혈정황월중만성간병간경화환자간경도치급비경도치월고；순시탄성성상기술가이유효지예측만성간병간경화환자간경화정도、식관위저정맥곡장파렬출혈적풍험。
Objective To measure liver and spleen stiffness values of patients with chronic liver disease and cirrhosis by transient elastography(FibroScan),and evaluate the differences in liver and spleen values among patients with different Child- Pugh grades,degrees of esophagogastric varices and bleeding status. Methods Enrolled 340 patients with chronic liver and cirrhosis who underwent electron gastroscopy and were hospitalized in Tianjin Third Hospital from April 2011 to December 2014, among which 170 patients were with hepatitis B and liver cirrhosis,35 patients were with hepatitis C and liver cirrhosis,46 patients were with primary biliary cirrhosis,55 patients were with alcoholic liver cirrhosis,and 34 patients were with autoimmune hepatitis and cirrhosis. A series of examinations were conducted including blood routine examination,coagulation convention examination,liver function examination,electron gastroscopy,abdominal color doppler ultrasound and the examination of liver and spleen stiffness values by transient elastography. Comparison was made in liver and spleen stiffness values among patients with different Child - Pugh grades,degrees of gastric varices and bleeding status. Results Patients of Child - Pugh B and Child -Pugh C had higher liver and spleen stiffness values than those patients of Child - Pugh A(P < 0. 05);patients of Child - Pugh C had higher liver and spleen stiffness values than those patients of Child - Pugh B(P < 0. 05). Patients with mild varicosity, moderate varicosity and severe varicosity had higher liver and spleen values than patients without varicosity(P < 0. 05);patients with moderate varicosity and severe varicosity had higher liver and spleen values than patients with mild varicosity(P < 0. 05);patients with severe varicosity had higher liver and spleen values than patients with moderate varicosity(P < 0. 05). Patients who had bleeding once and repeated bleeding had higher liver and spleen values than patients who had no bleeding( P < 0. 05);patients who had repeated bleeding had higher liver and spleen values than patients who had bleeding for only once(P < 0. 05). Conclusion Higher Child - Pugh grading,higher degree of esophagogastric variceal bleeding and severer bleeding in patients with chronic liver disease and liver cirrhosis are associated with higher liver and spleen values;transient elastography can effectively predict the degree of liver cirrhosis and the risk of esophagogastric variceal bleeding in these patients.