血管紧张素Ⅱ联合PGA指数对酒精性肝病、食管胃底静脉曲张及出血的预测意义

徐艳丽 邓敏 吴一鸣

[摘要] 目的 探討血管紧张素Ⅱ（AngⅡ）联合PGA指数无创性评估酒精性肝病患者食管胃底静脉曲张程度及出血风险。 方法 选取2017年6月～2018年6月嘉兴市第一医院收治的82例酒精性肝病患者，用胃镜检查评估食管胃底静脉曲张的程度，并测定血AngⅡ水平，计算PGA指数。比较不同食管胃底静脉曲张程度患者的AngⅡ水平和PGA指数。随访6个月，对AngⅡ和PGA指数预测出血的诊断效能进行比较。 结果 胃镜下食管胃底静脉曲张0级组、1级组、2级组、3级组的AngⅡ分别为（2318.621±346.043）pg/mL、（2867.420±383.144）pg/mL、（3430.193±686.725） pg/mL、（4204.723±997.436） pg/mL，PGA指数分别为（2.858±0.210）、（3.848±0.265）、（5.446±0.585）、（7.944±0.891）。AngⅡ和PGA指数均与食管胃底静脉曲张的严重程度相关，AngⅡ的相关系数为0.701，P=0.001;PGA指数的相关系数为0.774，P=0.013。随访6个月出血组的AngⅡ为（3705.471±784.323） pg/mL，PGA指数为（6.591±2.094）;未出血组的AngⅡ为（3185.862±914.118）pg/mL，PGA指数为（4.851±2.234）。出血组AngⅡ（敏感度0.765，特异度0.646）和PGA指数（敏感度0.882，特异度0.523）均明显高于未出血组，差异有统计学意义（P<0.05）。 结论 AngⅡ联合PGA指数能良好预测酒精性肝病患者食管胃底静脉曲张程度及出血风险，为临床医生及时判断病情、采取进一步措施提供指导意见。

[关键词] 血管紧张素Ⅱ;PGA指数;酒精性肝病;食管胃底静脉曲张;出血

[中图分类号] R575.5          [文献标识码] A          [文章编号] 1673-9701（2020）16-0028-04

The predictive significance of angiotensin II combined with PGA index for esophagogastric varices and bleeding in alcoholic liver disease

XU Yanli1 DENG Min1 WU Yiming2

1.Department of Infection， Jiaxing City the First Hospital in Zhejiang Province， Jiaxing   314000， China; 2.Institute of Hepatology， Jiaxing City the First Hospital in Zhejiang Province， Jiaxing   314000， China

[Abstract] Objective To explore the noninvasive evaluation of angiotensin II （Ang II） combined with PGA index for the degree of esophagogastric varices and the risk of bleeding in patients with alcoholic liver disease. Methods A total of 82 patients with alcoholic liver disease admitted to Tiaxing City First Hospital from June 2017 to June 2018 were selected for gastroscopy to evaluate the degree of esophagogastric varices. The blood Ang II level was determined， and the PGA index was calculated. The Ang II level and PGA index of patients with different esophagogastric varices were compared. The patients were followed up to 6 months. The diagnostic efficacy of Ang II and PGA index in predicting bleeding was compared. Results The Ang II of gastroscopic esophagogastric varices degree 0 group， degree 1 group， degree 2 group and degree 3 group were （2318.621±346.043）pg/mL， （2876.420±383.144）pg/mL， （3340.193±686.725） pg/mL， and （4204.723±997.436）pg/mL， and the PGA indexes were （2.858±0.210）， （3.848±0.265）， （5.446±0.585）， and （7.944±0.891） respectively. Both Ang II and PGA index were related to the severity of esophagogastric varices. The correlation coefficient of Ang II was 0.701， P=0.001. The correlation coefficient of PGA index was 0.774， P=0.013. After 6 months of follow-up， the Ang II and the PGA index was （3705.471±784.323） pg/mL and （6.591±2.094） in the bleeding group. The Ang II of the non-bleeding group was（3185.862±914.118） pg/mL， and the PGA index was （4.851±2.234）. The Ang II （sensitivity 0.765， specificity 0.646） and PGA（sensitivity 0.882， specificity 0.523） indexes in the bleeding group were significantly higher than those in the non-bleeding group， and the difference was statistically significant（P<0.05）. Conclusion Ang II combined with PGA index can well predict the degree of esophagogastric varices and bleeding risk in patients with alcoholic liver disease. It can provide guidance advice for clinical doctors to timely judge the condition and take further measure.

[Key words] Angiotensin II; PGA index; Alcoholic liver disease; Esophagogastric varices; Bleeding

我国目前有数量庞大的饮酒者，饮酒时间超过5年，或2周内大量饮酒均有导致酒精性肝病的风险[1]。对于该类人群如不及时干预，病情会由初起时的轻型酒精性肝病逐渐发展为酒精性脂肪肝、酒精性肝炎，最终进展为酒精性肝硬化，并引起肝功能衰竭及各种并发症，其中食管胃底静脉曲张破裂出血是最严重的并发症及死亡原因之一[2]。多项研究指出，肝硬化伴急性上消化道出血者，出血急性期病死率可高达30%[3]。因此，临床医生如能及时筛选出食管胃底静脉曲张程度重、出血风险大的患者，并采取相应的干预措施，对降低肝病患者出血率、改善预后、提高生存率具有重要意义。……