肝硬化患者门静脉高压性肠病的主要预测因素。

Major predictors of portal hypertensive enteropathy in patients with liver cirrhosis.

作者信息

Aoyama Taiki, Oka Shiro, Aikata Hiroshi, Igawa Atsushi, Nakano Makoto, Naeshiro Noriaki, Yoshida Shigeto, Tanaka Shinji, Chayama Kazuaki

机构信息

Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.

出版信息

J Gastroenterol Hepatol. 2015 Jan;30(1):124-30. doi: 10.1111/jgh.12658.

DOI:10.1111/jgh.12658

PMID:24988903

Abstract

BACKGROUND AND AIM

Portal hypertensive enteropathy (PHE) is acknowledged as a source of bleeding, and predicting its presence has become more important. We assessed PHE using capsule endoscopy (CE) and investigated factors that may predict its presence, including portosystemic shunts (PSs).

METHODS

We analyzed data from 134 consecutive patients with liver cirrhosis, from February 2009 to September 2013. All patients had undergone dynamic computed tomography and esophagogastroduodenoscopy before CE examination. The frequencies and types of PHE lesions, and the relationships between the presence of PHE and patients' clinical characteristics were evaluated. The distribution of the lesions was also determined.

RESULTS

PHE was found in 91 (68%), erythema in 70 (52%), erosions in 25 (19%), angioectasia in 24 (18%), villous edema in 18 (13%), and varices in 10 (7%) patients. Most lesions were located in the jejunum. The clinical characteristics associated with the presence of PHE were a Child-Pugh grade of B or C (P = 0.0058), and the presence of PSs (P < 0.0001), ascites (P = 0.0017), portal thrombosis (P = 0.016), esophageal varices (P = 0.0017), and portal hypertensive gastropathy (P = 0.0029). The presence of PSs was an independent predictor of PHE (odds ratio [OR]: 3.15; 95% confidence interval [CI]: 1.27-7.95). Among the shunt types, left gastric vein (OR: 5.31; 95% CI: 1.97-17.0) and splenorenal shunts (OR: 4.26; 95% CI: 1.29-19.4) were independent predictors of PHE.

CONCLUSION

PSs, especially left gastric vein and splenorenal shunts, appear to reliably predict the presence of PHE.

摘要

背景与目的

门脉高压性肠病（PHE）被认为是出血的一个来源，预测其存在变得愈发重要。我们使用胶囊内镜（CE）评估PHE，并调查可能预测其存在的因素，包括门体分流（PSs）。

方法

我们分析了2009年2月至2013年9月期间连续134例肝硬化患者的数据。所有患者在CE检查前均接受了动态计算机断层扫描和食管胃十二指肠镜检查。评估了PHE病变的频率和类型，以及PHE的存在与患者临床特征之间的关系。还确定了病变的分布情况。

结果

91例（68%）患者发现有PHE，70例（52%）有红斑，25例（19%）有糜烂，24例（18%）有血管扩张，18例（13%）有绒毛水肿，10例（7%）有静脉曲张。大多数病变位于空肠。与PHE存在相关的临床特征为Child-Pugh分级为B或C（P = 0.0058）、存在PSs（P < 0.0001）、腹水（P = 0.0017）、门静脉血栓形成（P = 0.016）、食管静脉曲张（P = 0.0017）和门脉高压性胃病（P = 0.0029）。PSs的存在是PHE的独立预测因素（优势比[OR]：3.15；95%置信区间[CI]：1.27 - 7.95）。在分流类型中，胃左静脉（OR：5.31；95% CI：1.97 - 17.0）和脾肾分流（OR：4.26；95% CI：1.29 - 19.4）是PHE的独立预测因素。