论文标题:肝硬化合并胆囊结石的相关因素研究
The Related Factors between Liver Cirrhosis and Gallbladder Stone
论文作者 陈林
论文导师 王建国,论文学位 硕士,论文专业 内科学
论文单位 浙江大学,点击次数 130,论文页数 36页File Size1219k
2005-04-01论文网 http://www.lw23.com/lunwen_1832532/ 肝硬化;胆囊结石;Child-pugh分级;门脉高压
liver cirrhosis; gallstone; Child-pugh class; portal hypertension
肝硬化是一种由不同病因引起的慢性、进行性疾病,它在肝细胞广泛变性和坏死基础上产生肝脏纤维组织弥漫性增生,并形成再生结节和假小叶,导致正常肝小叶结构和血管解剖的破坏,临床上以肝功能下降与门静脉高压征为主要表现。肝硬化分布遍及全世界,在我国也是多发病。胆囊结石的形成则主要与胆道感染、胆固醇过饱和、胆囊收缩功能异常、胆汁成分性质改变相关。肝脏是胆汁产生的主要器官,胆汁的正常代谢很大程度上依赖肝脏的正常形态和功能,所以,肝脏与胆囊结石的形成被认为有密切关系。大量临床资料也表明肝硬化患者胆囊结石的发生率明显增高,约为一般人群的4.5倍。由于B超、CT和MRI等影像学检查的普及和近年来肝硬化并发症治疗的进展,使肝硬化患者生存时间延长,肝硬化合并胆囊结石再次成为临床关注的热点,但至今为止肝硬化与胆囊结石的关系仍未取得一致性意见。 目的 通过回顾性分析122例肝硬化住院病人,研究肝硬化患者胆囊结石发生率,并探讨肝硬化患者发生胆囊结石的相关影响因素。 资料与方法 本研究回顾性分析经肝功能、凝血功能及B超检查的邵逸夫医院消化科122
Liver cirrhosis is a chronic , progressive disease, which is the end result of hepatocellular degeneration and necrosis that leads to both fibrosis and nodular regeneration throughout the liver, cirrhosis spreads all over the world, also in China. The primary clinical features of cirrhosis result from liver disfunction and portal hypertension. Gallstones" formation mostly related with impaired gallbladder contractility, biliary tract infection ,cholesterol supersaturation and changed composition of bile. Liver is the primary organ that produces bile, bile"s metabolization mostly relies on the normal form and function of liver, therefore, it is considered that there is significant relationship between the liver and the formation of gallstones, it has been noted that gall-stones are common in patients suffering from cirrhosis, which is 4-5 times higher than general population. Since the invention of B-ultrasonography, CT and MRI and the therapeutic progression of cirrhotic complications, it prolongs the survival length of the cirrhotic patients. So, attention were again paid to the prevalence of gallstones in cirrhotics. As yet, it is not clear whether cirrhosis related with the riskfactor,such as age, previous alcohol abuse, child-pugh, serum levels of albumin and ascites, influences gallstones increased frequency.ObjectiveWe retrospectively studied one hundred and twenty two cirrhotic inpatients, aimed to evaluate the prevalence of gallstones and related risk factors in a large series of patients with cirrhosis.MethodsOne hundred and twenty two consecutive cirrhotic patients (16 Child A, 34 Child B and 72 Child C) hospitalized in the department of gastroenterology of Sir Run Run Shaw Hospital, between January 2001 and January 2004, were included.liver function tests, coagulation function and abdominal B-ultrasonography were performed , all these patients were confirmed as suffering from liver cirrhosis. Aimed to evaluate the frequency of gallstones and study the relationship between gallstones and gender, age, previous alcohol abuse, Child-pugh, the inside diameter of portal vein, serum levels of albumin and total bilirubin, prothrombin time, gallbladder wall thickening and ascites.ResultsThe overall prevalence of gallstones was 29.51%(36/122) in our cirrhotic patients ,more higher than that of the control group(5.70%,13/228).Of the 122 study subjects ,twenty-eight of the 78 inpatients(35.90%) in the group of inside diameter of portal vein >13mm had gallstones, far higer than that of the inside diameter of portal vein≤13mm(18.18%), P<0.05. The prevalence of gallstones significantly difference between Child"s class A (2/16,12.50%) ,Child"s class B(6/34,17.65%) and Child"s class C (28/72,38.89%), P<0.01. Logistic regression analysis showed that the presence of ascites and Child-pugh were the risk factors for the gallstones in patients with liver cirrhosis (0R=4.019, P=0.002; 0R=4.062, P=0.040) . No relationships with the factors for the prevalence of gallstones in liver cirrhosis, such as age , sex, previous alcoholabuse, serum levels of albumin , gallbladder wall thickening or prothrombin time,were found.Conclusions1. Gallstones in our cirrhotic patients more prevalent than in general population.2. Sex, Age , previous alcohol abuse, serum levels of albumin, gallbladder wall thickening and prothrombin time did not influence in gallstones prevalence in our cirrhotic patients.3. Child-Pugh class and presence of ascites were the risk factor for the gallstones in patients with liver cirrhosis.4. The severity of liver disfunction and portal hypertension may be associated with an in increased risk of gallstone formation, the patients with severe liver function and higher portal pressure are more likely to have gallstones.
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