乙型肝炎肝硬化失代偿期患者首发食管静脉曲张出血或腹水的临床特征

Clinical characteristics of decompensated liver cirrhosis of hepatitis B virus related with first onset esophageal variceal bleeding or ascites

目的比较乙型肝炎肝硬化失代偿期患者首发食管静脉曲张破裂出血或首发腹水的检验学和超声影像学方面的差异。方法回顾性研究2005年-2007年50例乙型肝炎肝硬化失代偿期患者首发以食管静脉曲张破裂出血或腹水住院者的血液分析、肝肾功能、电解质及门脾静脉宽度等资料。性别分层分析这些资料的改变与出血和腹水之间的关系。结果乙型肝炎肝硬化失代偿期首发食管静脉曲张破裂出血患者的血红蛋白显著低于以腹水为首发症状的乙型肝炎肝硬化失代偿期患者（P〈0.05）,而血糖则显著高于后者（P〈0.01）。出血组女性患者红细胞总数显著低于腹水组男性患者（P〈0.05）,出血组男女患者的血钠都显著高于腹水组男性患者（P〈0.05,0.0001）,腹水组男性血钠显著低于女性（P〈0.05）。腹水组平均发病年龄大于出血组,但差异无显著性（P〉0.05）。两组之间在白蛋白水平、凝血酶原时间、白细胞总数、血小板总数、血钾、血肌酐、血尿素氮和门脾静脉宽度等方面均无显著性差异。结论乙型肝炎肝硬化失代偿期患者首发食管静脉曲张破裂出血者多见高血糖和低血红蛋白,首发腹水者男性更多见低血钠,表明乙型肝炎肝硬化失代偿期出血性损害更倾向侵袭男性患者。

Objective To compare the difference of laboratory and uhrasonography in patients with first onset esophageal variceal bleeding or ascites due to deeompensated liver cirrhosis of hepatitis B virus. Methods The data of blood analysis, biochemical test and width of portal vein and spleen vein collected from 50 patients with hepatitis B virus related liver cirrhosis in their decompensation period with first onset esophageal variceal bleeding or ascites during 2005 to 2007 were analyzed retrospectively. The relationship between the change of the data and bleeding or ascites were evaluated by sex grades. Results The level of hemoglobin was significantly lower in patients with first onset esophageal variceal bleeding than that in liver cirrhosis patients with aseites （P 〈 0.05） , otherwise serum glucose was significantly higher （P 〈 0. 01 ）. The erythrocyte in female patients with first onset esophageal variceal bleeding was significantly lower than that in liver cirrhosis patients with ascites （P 〈 0.05）. The serum sodium levels in male and female patients during acute first onset esophageal variceal bleeding were higher than that in male patients with ascites （P 〈 0. 0001 ）. The serum sodium level in male patients with ascites was lower than that in female patients （P 〈 0.05）. The mean age at onset in patients with ascites was higher than that in patients with variceal bleeding, but had no significance （P 〉 0. 05 ）. There were no significant difference between the two groups among serum albumin,prothrombin time, leukocyte, platelet, serum potassium, serum urea, creatinine and width of portal and spleen vein. Conclusion The patients with first onset esophageal variceal bleeding due to deeompensated liver cirrhosis of hepatitis B virus have more hyperglycemia and hypochromia. More male patients with ascites have hyponatremia. These data indicate that hemorrhagic impairment invasives more male patients.