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目的探讨血清总胆汁酸与肝硬化食管静脉曲张破裂出血(BEV)的关系。方法 86例肝硬化患者,根据胃镜检查分为BEV组(30例)和非BEV组(56例)。所有患者入院当日进行肝功能、凝血功能、血常规及肝纤维指标(层粘连蛋白、Ⅳ型胶原、透明质酸)检查。均采用保肝、支持、对症处理等治疗方法 ,合并BEV患者则给予止血、降低门脉压力治疗。比较两组层粘连蛋白、Ⅳ型胶原、透明质酸及血总胆汁酸水平情况,比较两组不同肝功能分级(Child-Pugh)间的胆汁酸水平。结果 BEV组患者血清层粘连蛋白、透明质酸水平明显高于非BEV组,Ⅳ型胶原、总胆汁酸水平明显低于非BEV组,差异均有统计学意义(P<0.05),BEV组Child-Pugh分级为A、B、C级的总胆汁酸水平明显低于非BEV组相对应的肝功能等级患者的血清总胆汁酸水平,差异均有统计学意义(P<0.05)。血清总胆汁酸、Child-Pugh功能分级是BEV发生的独立危险因素。结论血清总胆汁酸、层粘连蛋白、Ⅳ型胶原、透明质酸及Child-Pugh功能分级与BEV的发生密切相关,而血清总胆汁酸、Child-Pugh功能分级是BEV发生的独立危险因素。其可作为肝硬化患者并发BEV的预测指标。
Objective To investigate the relationship between serum total bile acid and cirrhotic esophageal variceal bleeding (BEV). Methods Totally 86 patients with liver cirrhosis were divided into BEV group (30 cases) and non-BEV group (56 cases) according to gastroscopy. All patients were admitted on the day of liver function, coagulation, blood and liver fibrosis indicators (laminin, collagen type Ⅳ, hyaluronic acid) examination. All adopt the methods of liver protection, supportiveness, symptomatic treatment and so on. Patients with BEV are given hemostasis to reduce portal pressure therapy. The levels of laminin, type IV collagen, hyaluronic acid and total bile acid in the two groups were compared, and the levels of bile acid in the two groups were compared between different liver function grades (Child-Pugh). Results The levels of serum laminin and hyaluronic acid in BEV group were significantly higher than those in non-BEV group. The levels of type Ⅳ collagen and total bile acid in BEV group were significantly lower than those in non-BEV group (P <0.05) The levels of total bile acids of -Pugh grade A, B and C were significantly lower than those of patients with non-BEV grade liver function grade, the difference was statistically significant (P <0.05). Serum total bile acid, Child-Pugh functional grading is an independent risk factor for BEV. Conclusions The serum levels of total bile acid, laminin, type Ⅳ collagen, hyaluronic acid and Child-Pugh are closely related to the occurrence of BEV. The serum total bile acid and Child-Pugh grading are independent risk factors for BEV. It can be used as a predictor of BEV in patients with cirrhosis.