肝炎后肝硬化门静脉高压性胃病的内镜特征分析

Endoscopic feature of patients with posthepatitic cirrhosis and portal hypertensive gastropathy

目的分析肝炎后肝硬化(LC)门静脉高压性胃病(PHG)的内镜像及临床特征。方法北京地坛医院2007年1月至2009年8月收治的768例LC患者,对经电子胃镜检查确诊合并PHG的100例作回顾性分析。结果 100例患者中轻度PHG59例,重度PHG41例,77例幽门螺杆菌(Hp)检测呈阳性。PHG内镜像特征:轻度:(1)黏膜表面细小红点灶(猩红热样疹);(2)在条纹状外观的黏膜皱褶表面出现表浅红斑;(3)红粉色水肿黏膜上出现黄白色网状间隔,类似蛇皮样或马赛克样改变。重度:黏膜出现樱桃红斑点和(或)弥漫出血性胃炎,其中以马赛克样改变最常见,且多发于胃底和胃体。结论猩红热样疹、马赛克样变、樱桃红斑点是PHG最具特征的内镜像。PHG的严重程度与肝功能分级呈正相关。PHG临床表现无明显特征性,只能通过胃镜检查确诊。

Objective To study endoscopic and clinical feature of patients with posthepatitic cirrhosis(LC)and portal hypertensive gastropathy(PHG).Methods Gastroscopy was performed in 768 patients with posthepatitic cirrhosis in Beijing ditan hospital from January 2007 to August 2009.A retrospective study was conducted in 100 cases diagnosed merger portal hypertension gastropathy.Results There are 59 cases with mild PHG and 41 cases with severe PHG,Helicobacter pylori(Hp)was detected in 77 cases.The gastroscopic images features of patients with mild PHG was that:(1)tiny red dot focal(scarlet fever pattern rash)on the mucosal surface,(2)shallow erythema on surface of mucosa ruffle with stripe shape,(3)yellowish-white reticular interval with red pink edema mucosa,the patterns of which was similar to the snake skin or mosaic pattern.The gastroscopic image features of patients with serve PHG showed that cherry red spot and(or)diffuses hemorrhagic gastritis.Change of mosaic pattern was most common on the fundus and gastric body.Conclusions Scarlet fever pattern rash,change of mosaic pattern and cherry red spot were the characteristics of PHG in patients with LC.The severity of PHG positively correlated with liver function classification.The clinical manifestations of PHG in patients with LC was not significant,we must diagnose PHG by gastroscopy.