门静脉高压论文：门静脉高压 肝静脉压力梯度 β-受体阻断剂 影响因素

门静脉高压论文：门静脉高压 肝静脉压力梯度 β-受体阻断剂 影响因素 门静脉高压论文:门静脉高压 肝静脉压力梯度 β-受体阻断剂 影响因素 【中文摘要】肝硬化是临床上常见的一种严重且不可逆的肝脏慢性病变,门静脉高压是其并发症之一,死亡率高。肝静脉压力梯度(HVPG)是诊断门静脉高压及判断非选择性β-受体阻断剂(NSBBs)疗效的金。非选择性β-受体阻断剂(NSBBs)是临床上推荐使用的降低门静脉压力的药物,但仅有1/3-1/2的患者对其反应良好。本研究探讨与肝静脉压力梯度(HVPG)相关的指标,并观察影响非选择性β-受体阻断剂(NSBBs)降低肝静脉压力梯度(HVPG)的相关因素,旨在探讨可预测非选择性β-受体阻断剂(NSBBs)有效降低肝静脉压力梯度(HVPG)评价指标。和:确诊肝硬化患者30例,常规行胃镜、上腹部多层螺旋cT(MDCT)、血常规、凝血酶原时间及肝功生化检查,行肝静脉压力梯度(HVPG)测定,均符合肝静脉压力梯度(HVPG)?10mmhg分析出血史、肝硬化病因、腹水、Child-Pugh评分及食管内粘膜下静脉曲张胃镜下分级对肝静脉压力梯度(HVPG)的影响;给予口服非选择性β-受体阻断剂(NSBBs)7天后复测肝静脉压力梯度(HVPG),肝静脉压力梯度(HVPG)降至12mmhg以下或下降幅度?基线水平20%者为“应答者”,未达到上述标准者为“非应答者”,对“应答者”与“非应答者”的年龄、性别、病因、出血史、腹水、基础心率及平均动脉压、血红蛋白(HGB)、红细胞压积(HCT)、门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、白蛋白(ALB)、血清总胆红素(SB)、 凝血酶原时间(PT)、肌酐(CR)、尿素氮(BUN)、Child-Pugh评分、食管内粘膜下静脉曲张胃镜下分级、食管旁静脉曲张MDCT评分、食管内粘膜下静脉曲张MDCT评分、门静脉主干(MPV)直径、脾静脉(SV)直径、肠系膜上静脉(SMV)直径、胃左静脉(LGV)直径、奇静脉(AV)直径、脾脏厚度、脐静脉再通及门静脉血栓等多因素进行比较分析。结果:肝静脉压力梯度(HVPG)的高低与出血史、肝硬化病因及食管内粘膜下静脉曲张胃镜下分级无关,与腹水及Child-Pugh评分有关;服用非选择性β-受体阻断剂(NSBBs)7天后,达到肝静脉压力梯度(HVPG)降至12mmhg以下或下降幅度?基线水平20%者,即“应答者”,共12例,未达到上述标准的“非应答者”共18例,应答率为40%,两组年龄、性别、病因、出血史、腹水、基础心率及平均动脉压、血红蛋白(HGB)、红细胞压积(HCT)、门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、白蛋白(ALB)、血清总胆红素(SB)、凝血酶原时间(PT)、肌酐(CR)、尿素氮(BUN)、Child-Pugh评分、食管内粘膜下静脉曲张胃镜下分级、食管旁静脉曲张MDCT评分、食管内粘膜下静脉曲张MDCT评分、门静脉主干(MPV)直径、脾静脉(SV)直径、肠系膜上静脉(SMV)直径、胃左静脉(LGV)直径、奇静脉(AV)直径、脾脏厚度、脐静脉再通及门静脉血栓之间的差异均不具有统计学意义。结论:本研究发现肝静脉压力梯度(HVPG)与肝硬化患者的腹水及Child-Pugh评分有明显相关性;非选择性β-受体阻断剂(NSBBs)降低肝静脉压力梯度(HVPG)的有效“应答率”为40%,“非应答率”为60%;患者肝硬化程度、肝功能储备分级及静脉曲张程度等指标对非选择性β-受体阻断 剂(NSBBs)降低肝静脉压力梯度(HVPG)的疗效无明显影响。 【英文摘要】s:Cirrhosis is a serious and irreversible chronic liver lesions. The portal hypertension is one of its complications, which has a high mortality rate. The non-selective beta blockers (NSBBs) is the clinical recommended drugs for reducing portal vein pressure, however, only 1/3-1/2 patients respond well to it.This study aims to observe impact factors of hepatic vein pressure gradient (HVPG), the effect and Influence factors of non-selective beta blockers (NSBBs).Materials and Methods:After the examination of gastroscope, epigastrium MDCT (MDCT), blood routine tests, prothrombin time and liver biochemical tests,30 cases of patients with liver cirrhosis underwent hepatic venous pressure gradient (hvpg) measurements. All of the patients had a hepatic venous pressure gradient (hvpg)?10mmhg.The study was to evaluate relationships between hepatic venous pressure gradient (hvpg) with history of variceal bleeding, etiology of liver disease, ascites, Child-Pugh class and the grade of esophageal variceal. Hepatic venous pressure gradient measurements were undertaken after receiving Carvedilol for 7 days. Comparion of “responders” (those that reduced HVPG<12mmhg or?2o%) and “non-responders” (those that were not up to the standard) was taken to show if there had any significant differences in age, sex, etiology, bleeding history, ascites, basic heart rate and basic mean arterial pressure, hemoglobin, hematocrit, aspartate aminotransferase, alanine aminotransferase, albumin, serum bilirubin, prothrombin time, creatinine, urea nitrogen, Child-Pugh score, grade of esophageal varices, the MDCT score of paraesophageal varices and esophageal varices, main portal vein diameter, splenic vein diameter, superior mesenteric vein diameter, left gastric vein diameter, azygous vein diameter, splenic thickness, umbilical vein reascularization and portal vein thrombus.Result: Hepatic enous pressure gradient (HVPG) was related to ascites and Child-Pugh score, not to Bleeding history, etiology and gastroscope grade. There were 12 cases of responders(40%). No difference was finding between the responders and non-responders.Conclusion:Hepatic venous pressure gradient (HVPG) was associated with Ascites and Child-Pugh score, “response rate” was 40%, “non-response rate” was 60%. The degree of cirrhosis, liver reserve function and varicose veins did not influence the reduction of hepatic venous pressure gradient (HVPG) by non-selective beta blockers (NSBBs). 【关键词】门静脉高压 肝静脉压力梯度 β-受体阻断剂 影响因素 【采买全文】 1.3.9.9.38.8.4.8 1.3.8.1.13.7.2.1 同时提供论文写作定制和论文发服务.保过包发. 【说明】本文仅为中国学术文献总库合作提供，无涉版权。作者如有异议请与总库或学校联系。 【英文关键词】Portal hypertension Hepatic venous pressure gradient Non-selective beta blockers Influence factors 【目录】影响非选择性β-受体阻断剂降低肝静脉压力梯度的多因素分析 中文摘要 6-8 ABSTRACT 8-9 符号说明 10-11 前言 11-13 材料与方法 13-20 结果 20-24 讨论 24-29 结论 29-30 附图 30-35 参考文献 35-40 综述 40-57 综述参考文献 50-57 致谢 57-58 学位论文评阅及答辩情况表 58