Aiello A, Calapristi I, Freni M A, Fava A, Scarpignato E M, Spadaro A, Ferraú O
Istituto Pluridisciplinare di Clinica Medica, Università di Messina.
Minerva Gastroenterol Dietol. 1993 Mar;39(1):1-5.
Hundred-forty-one patients, 78 affected by alcoholic liver cirrhosis and 63 by posthepatitic cirrhosis were studied in order to assess the degree of portal hypertension in liver cirrhosis of different etiology taking into account the developing stages of the disease. Etiological assessment was based on anamnesis, laboratory data, needle liver biopsy and patients of each group were divided into 3 subgroups (grade A, B, C) according to Child-Turcotte classification. A > 1.3 cm diameter of portal vein and a > 13 cm spleen size evaluated by means of real-time ultrasonography together with the occurrence of esophageal varices at endoscopy were considered as signs of portal hypertension. Our study shows that such signs are more frequent in patients affected by posthepatitic cirrhosis in comparison with those affected by alcoholic cirrhosis. If the severity of the disease was considered, at the early stage (grade A) no significant difference was reported in portal diameters while splenomegaly and esophageal varices appeared more frequent in posthepatitic cirrhosis. In grade B patients the increase of portal and spleen size proved significantly greater in posthepatitic cirrhosis whereas prevalence of esophageal varices was similar in the two groups. The lack of differences in the three considered parameters at the end stage of the disease may be due to severe changes in liver morphology actually similar in the 2 groups apart from etiological factors.
为了评估不同病因肝硬化患者门静脉高压的程度,并考虑疾病的发展阶段,我们对141例患者进行了研究,其中78例为酒精性肝硬化患者,63例为肝炎后肝硬化患者。病因评估基于病史、实验室数据、肝脏穿刺活检,每组患者根据Child-Turcotte分类法分为3个亚组(A级、B级、C级)。通过实时超声检查评估门静脉直径>1.3 cm和脾脏大小>13 cm,以及内镜检查时出现食管静脉曲张被视为门静脉高压的征象。我们的研究表明,与酒精性肝硬化患者相比,肝炎后肝硬化患者出现这些征象的频率更高。如果考虑疾病的严重程度,在早期(A级),门静脉直径无显著差异,但肝炎后肝硬化患者脾肿大和食管静脉曲张更为常见。在B级患者中,肝炎后肝硬化患者门静脉和脾脏大小的增加明显更大,而两组食管静脉曲张的发生率相似。在疾病末期,所考虑的三个参数缺乏差异可能是由于除病因因素外,两组肝脏形态实际上相似的严重变化所致。