肝硬化合并乳糜性胸腹水诊断和治疗的病例系列研究

Clinical characteristics,diagnosis and treatment of liver cirrhosis combined with coeliacal pleural ascites:A case series study

目的 探讨肝硬化合并乳糜性胸腹水的临床特征、诊断及治疗。方法 选取2022年3月—2023年3月我院收治的肝硬化合并乳糜性胸/腹水患者4例,收集其临床特征及实验室数据,并给予大剂量人血白蛋白联合生长抑素类似物治疗,观察其疗效及预后。结果 (1)患者平均年龄61±8.91岁,男性占3/4;3例病因为乙型肝炎病毒感染,1例为酒精;3例合并肾功能不全,2例出现低蛋白血症;2例Child-Pugh分级为C级,1例合并肝肾综合征、MELD评分大于20;(2)3例积液外观呈乳糜样,1例表现为淡黄色;3例乳糜微粒阳性,3例同时存在乳糜性胸腹水,1例单纯乳糜性胸水、1例单纯乳糜性腹水;(3)给予大剂量人血白蛋白后4例患者积液均较前消退,血肌酐好转,随访1月、3月、6月后3例患者病情稳定,1例在随访4月后死亡。结论 乳糜性胸腹水患者给予大剂量白蛋白联合生长抑素类似物治疗有助于积液消退,改善患者肾功能,提高患者生活质量。

Objective To investigate the features,diagnosis and treatment of liver cirrhosis complicated with chylothorax and/or chylous ascites.Methods Select 4 patients with liver cirrhosis complicated with chylothorax/chylous ascites admitted to our hospital from March 2022 to March 2023,collect their characteristics and laboratory data,and give high-dose human albumin combined with somatostatin analog therapy,and observe its curative effect and prognosis.Results(1)The average age of the patients was 61±8.91 years old,and 3/4 were male;3 cases were caused by hepatitis B virus infection,1 case was alcohol;3 cases were complicated with renal insufficiency,2 cases had hypoproteinemia;2 cases The Child-Pugh classification was grade C,1 case was complicated with hepatorenal syndrome,and the MELD score was greater than 20;(2)3 cases had chylomicron appearance,and 1 case was light yellow;3 cases were positive for chylomicrons,and 3 cases were present at the same time chylothorax and ascites effusion,1 case of pleural effusion,1 case of chylous ascites;(3)After administration of large doses of human serum albumin,the effusions of four patients all subsided compared with before,and the serum creatinine improved.Patients were followed up at 1 month,3 months,and 6 months after discharge;three patients were in stable condition,and one patient died after four months of follow-up.Conclusion The treatment of patients with chylothorax/chylous ascites with high-dose albumin combined with somatostatin analogues can help the effusion subside,improve the renal function and even the quality of life of the patients.