30岁以下人群食管胃静脉曲张患者临床特点分析

Clinical features of patients with gastroesophageal varices under 30 years old

目的分析总结30岁以下食管胃静脉曲张(GOV)患者的临床特点。方法2015年1月~2020年12月解放军总医院第一医学中心消化内科医学部收治的61例30岁以下GOV患者,提取、分析和总结其临床资料。结果在61例GOV患者中,肝硬化门静脉高压症27例(44.3%),其中隐源性肝硬化占40.7%,乙型肝炎肝硬化占33.3%,和非肝硬化性门静脉高压(NCPH)34例(55.7%),其中以门静脉海绵样变占61.8%;基于内镜下静脉曲张LDRf分型,在位置方面主要以Le/g型多见(77.1%),在直径方面,D1.0占41.0%,在出血风险方面,Rf1分级占77.1%;针对GOV治疗,以二级预防治疗为主(85.7%),多采用组织胶或硬化剂注射或套扎联合治疗(66.1%);NCPH患者GOV再出血比例为11.8%,显著低于肝硬化组的29.6%(P<0.01)。结论30岁以下人群GOV患者以NCPH居多,其中以各种原因引起的门脉海绵样变最多见。NCPH患者并发GOV经内镜治疗后再出血发生率显著低于肝硬化患者。

Objective The aim of this study was to summarize the clinical features of patients with portal hypertension and gastroesophageal varices(GOV)under 30 year old of age.Methods The clinical data of 61 inpatients with GOV aged under 30 year old encountered between January 2015 and December 2020 were retrospectively summarized.Results Out of the 61 patients with GOV,the cirrhotic portal hypertension were found in 27 patients(44.3%),including cryptogenic cirrhosis in 11 patients(40.7%),and hepatitis B cirrhosis in 9 patients(33.3%),and noncirrhotic portal hypertension(NCPH)were found in 34 cases(55.7%),including cavernous transformation of portal vein in 21 patients(61.8%);as for the LDRf classification,the varices in our series were mainly Le/g type,accounting for 77.1%,in terms of diameter,D1.0 for 41.0%,and in terms of bleeding risk factor,the Rf grade 1 were more common(77.1%);the secondary prevention was the main treatment(85.7%),and tissue glue and sclerosing agent injection or band ligation combination was commonly administered(66.1%)in our series;the incidence of rebleeding in patient with NCPH was 11.8%,significantly lower than 29.6%in patients with liver cirrhosis(P<0.01).Conclusion The majority of young patients with GOV have portal hypertension caused by non-cirrhotic factors,and portal cavernous transformation is the main cause of NCPH.The rebleeding of esophageal and gastric varices in patients with NCPH is relatively lower than that in patients with liver cirrhosis.