Ekmen Nergis, Cifci Sami
Gastroenterology, Gazi University Faculty of Medicine, Ankara, TUR.
Gastroenterology, Başakşehir Çam and Sakura City Hospital, Istanbul, TUR.
Cureus. 2021 Feb 15;13(2):e13355. doi: 10.7759/cureus.13355.
Esophageal varices bleeding (EVB) in liver cirrhosis is an important cause of mortality and morbidity. We aimed to study the relationship between systolic pulmonary artery pressure (sPAP) and EV grade and EVB.
A total of 229 patients, 183 male and 46 female, who were determined to have EV in the upper gastrointestinal tract endoscopy and who had a transthoracic echocardiogram (TTE) were included in this study.
The frequency of pulmonary hypertension (PHT) and EVB was determined to be 16% and 45%, respectively, in our study, and 20% of those who had bleeding had PHT; 70.3% of the cases with PHT were determined to have grade III varices while this rate was lower at 52.9% in cirrhosis without PHT. A significant correlation was determined between Model for End-Stage Liver Disease (MELD) score, Child-Turcotte-Pugh score, platelet, albumin, and sPAP in those without a history of bleeding (p<0.05).
An increase in the rate of grade III varices has been noted along with the prevalence of PHT in patients with portal hypertension. It has been determined that the increase in PAP is associated with an increase in the MELD score, which is closely associated with mortality and morbidity. Therefore, this positive relationship between the MELD score and PHT may lead to an increase in the frequency of advanced-stage EV.
肝硬化患者食管静脉曲张破裂出血(EVB)是导致死亡和发病的重要原因。我们旨在研究收缩期肺动脉压(sPAP)与食管静脉曲张(EV)分级及EVB之间的关系。
本研究纳入了229例患者,其中男性183例,女性46例,这些患者均经上消化道内镜检查确诊为EV,并接受了经胸超声心动图(TTE)检查。
在我们的研究中,肺动脉高压(PHT)和EVB的发生率分别为16%和45%,出血患者中有20%患有PHT;PHT患者中有70.3%被确定为III级静脉曲张,而在无PHT的肝硬化患者中这一比例较低,为52.9%。在无出血史的患者中,终末期肝病模型(MELD)评分、Child-Turcotte-Pugh评分、血小板、白蛋白和sPAP之间存在显著相关性(p<0.05)。
门静脉高压患者中,随着PHT患病率的增加,III级静脉曲张的发生率也有所上升。已确定PAP的升高与MELD评分的增加相关,而MELD评分与死亡率和发病率密切相关。因此,MELD评分与PHT之间的这种正相关关系可能导致晚期EV的发生率增加。