老年人肝硬化侧支循环形成的临床特点分析

Analysis of clinical characteristics for the collateral circulation in elderly patients with hepatic cirrhosis

目的探讨老年肝硬化患者门体循环之间侧支血管形成的临床特点及临床意义。方法对临床确诊为肝硬化的患者运用64排螺旋CT和三维血管成像结合电子胃镜检查，观察门体循环之间侧支血管形成。结果老年组上消化道出血的发生率为32．2％，非老年组为34．9Vo，差异无统计学意义（X2=0．253，P=0．615）；老年组腹水和肝性脑病及慢性血氨升高的发生率分别为59．6％和38．4％，非老年组分别为48．0％和22．3％，老年组均高于非老年组（X2=4．294、9．866，P=0．038、0．002）。老年组侧支循环的发生率显著高于非老年组（87．0％比78．3％，X2=4．126，P=0．042）；两组有侧支循环形成患者间比较，上消化道出血与腹水的发生率差异无统计学意义（X2=1．761，P=0．185，X2=2．391，P=0．122），但老年组肝性脑病及慢性血氨升高的发生率仍显著高于非老年组（X2=7．104，P=0．008）。结论老年肝硬化患者侧支循环的发生率高于非老年组，腹水、肝性脑病及慢性血氨升高的发生率高于非老年组。侧支循环的建立有助降低老年肝硬化患者门静脉高压，使得腹水的发生率降低，但增加了肝性脑病及慢性血氨升高的发生率。

Objective To analyse the clinical characteristics for the collateral circulation in elderly patients with hepatic cirrhosis. Methods From May 2010 to June 2012, 146 elderly liver cirrhosis inpatiems [78 males and 68 females, aged （64.8±4.0） years] and 175 non-elderly liver cirrhosis inpatients [94 males and 81 females, aged （47.2±10.2） years] were selected at random. 64- slice spiral CT angiography, 3D digital subtraction angiography and gastroscopy were applied in observing the collateral circulation in patients with hepatic cirrhosis. Results The incidence of variceal hemorrage was 32.19% in elderly patient group, and there was no significance between the elderly and young patients （X2 = 0. 253, P = 0. 615）. But the incidences of ascites and hepatic encephalopathy were 59.6% and 38.4% in the elderly patient group, which were significantly higher than those in the young patient groups （48.0%,22.3%） （252=4.294,P=0.038,252=9.866,P= 0. 002）. The incidence of collateral circulation was 87.0% in the elderly patient group, much higher than that in the young patient group （78.3%） （X2= 4.126,P=0.042）. The incidence of variceal hemorrhage and ascites were almost the same in the patients with collateral circulation in both elderly and young patient groups （X2 =1. 761,P=0.185,X2 =2.391,P=0.122）, while the incidence of hepatic encephalopathy in patients with collateral circulation in elderly patient group was significantly higher than that in young patient group（X^2=7. 104, P = 0. 008）. Conclusions The incidence of collateral circulation, ascites and hepatic encephalopathy were significantly higher in the old patient group than those in the young patient group. The formation of collateral circulation may help reduce the portal hypertension, decrease the incidence of ascites in the elderly patients with hepatic cirrhosis, but increase the incidence of hepatic encephalopathy in those patients.