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中华移植杂志(电子版)

中华移植杂志(电子版) ›› 2020, Vol. 14 ›› Issue (03) : 149 -153. doi: 10.3877/cma.j.issn.1674-3903.2020.03.004

所属专题： 文献；

论著

乙型肝炎相关性终末期肝病肝移植受者术后上消化道疾病的初步调查
解曼1, 张群2, 毛涛1, 田字彬1, 臧运金2, 饶伟2,†()   
  1. 1. 266000　青岛大学附属医院消化内科
    2. 266000　青岛大学附属医院器官移植中心　肝脏病中心
  • 收稿日期:2019-10-04 出版日期:2020-06-25
  • 通信作者: 饶伟
  • 基金资助:
    青岛大学附属医院青年科研基金(NO. 3453)

Preliminary investigation of upper gastrointestinal tract diseases among liver transplant recipients with HBV-related end-stage liver disease

Man Xie1, Qun Zhang2, Tao Mao1, Zibin Tian1, Yunjin Zang2, Wei Rao2,†()   

  1. 1. Department of gastroenterology, Affiliated Hospital of Qingdao Universtiy, Qingdao 266000, China
    2. Departemnt of Organ transplantation, Affiliated Hospital of Qingdao Universtiy, Qingdao 266000, China
  • Received:2019-10-04 Published:2020-06-25
  • Corresponding author: Wei Rao
  • About author:
    Corresponding author: Rao Wei, Email:
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引用本文：

解曼, 张群, 毛涛, 田字彬, 臧运金, 饶伟. 乙型肝炎相关性终末期肝病肝移植受者术后上消化道疾病的初步调查[J]. 中华移植杂志(电子版), 2020, 14(03): 149-153.

Man Xie, Qun Zhang, Tao Mao, Zibin Tian, Yunjin Zang, Wei Rao. Preliminary investigation of upper gastrointestinal tract diseases among liver transplant recipients with HBV-related end-stage liver disease[J]. Chinese Journal of Transplantation(Electronic Edition), 2020, 14(03): 149-153.

目的

调查乙型肝炎相关性终末期肝病肝移植(以下简称乙肝肝移植)受者上消化道疾病的发生情况，并对其影响因素进行初步探讨。

方法

对2006年7月至2018年12月青岛大学附属医院符合入选标准的63例乙肝肝移植受者进行电子胃镜检查。同时，以年龄和性别作为匹配因素，按1 ∶3进行倾向性评分匹配，选取于本院行电子胃镜检查的慢性乙型肝炎患者和健康体检者各189例作为对照。比较3组受者消化系统症状和胃镜检出疾病情况，并进一步分析乙肝肝移植受者上消化道疾病发生的危险因素。

结果

乙肝肝移植组受者术后经胃镜检出的上消化道疾病主要包括慢性萎缩性胃炎(36/63，57.1%)、反流性食管炎(13/63，20.6%)及食管静脉曲张和/或胃底静脉曲张(10/63，15.9%)。乙肝肝移植受者慢性萎缩性胃炎发生率高于慢性乙型肝炎组和体检组(P均<0.017)，幽门螺旋杆菌感染发生率低于慢性乙型肝炎组和体检组(P均<0.017)。肝移植受者中，慢性萎缩性胃炎组年龄高于非慢性萎缩性胃炎组，分别为(58±8)岁和(51±7)岁，差异有统计学意义(t＝2.232，P<0.05)。

结论

乙肝肝移植受者术后上消化道疾病发生率高且种类多，其中慢性萎缩性胃炎和反流性食管炎最为常见，应重视肝移植受者术后电子胃镜定期筛查。

关键词: 肝移植, 慢性萎缩性胃炎, 反流性食管炎, 电子胃镜, 筛查
Objective

To investigate the incidence of upper gastrointestinal tract diseases among liver transplant recipients with HBV-related end-stage liver disease and to explore the influencing factors.

Methods

Sixty-three cases of live transplant recipients who meet the inclusion criteria (liver transplant group) were enrolled to perform the electronic gastroscopy between July 2006 and December 2018 in the Affiliated Hospital of Qingdao Universtiy. The age and gender were selected as matching factors, 189 cases of health examinors (health group) and 189 cases of chronic HBV infection patients (HBV infection group) were selected as control groups at the rate of 1∶3 with propensity score matching. The gastrointestinal symptoms and diseases detected by gastroscope of the above 3 groups were compared, and further analysed the risk factors which affected the occurrence of upper gastrointestinal tract diseases in liver transplant recipients with HBV-related end-stage liver disease.

Results

The most common upper gastrointestinal tract abnormalities in liver transplant recipients with HBV-related end-stage liver disease inculded chronic atrophic gastritis (36/63, 57.1%), reflux esophagitis (13/63, 20.6%) and esophageal varices/gastric varices (10/63, 15.9%). The incidence of chronic atrophic gastritis in liver transplant group was higher than other 2 groups (P all<0.017), the prevalence of Helicobacter pylori infection in liver transplant group was lower than other 2 groups (P all<0.017). In liver transplant recipients, the age of recipients with chronic atrophic gastritis [(58±8) years] was older than recipients without chronic atrophic gastritis [(51±7) years] (t=2.232, P<0.05).

Conclusions

Liver transplant recipients with HBV-related end-stage liver disease have high rate of upper gastrointestinal tract diseases, and chronic atrophic gastritis and reflux esophagitis are the commonest diseases among the various upper gastrointestinal tract diseases. More attention should be paid to the screening examination of electronic gastroscopy after liver transplantation.

Key words: Liver transplantation, Chronic atrophic gastritis, Reflux esophagitis, Electronic gastroscopy, Screening examination
表1 3组经胃镜检出的上消化道疾病比较
组别 例数 性别(女/男，例) 年龄(±s，岁) 反流性食管炎[例(%)] 胆汁反流[例(%)] 消化性溃疡[例(%)]
肝移植组 63 14/ 49 55±9 13(20.6) 6(9.5) 8(12.7)
慢性乙型肝炎组 189 38/151 53±8 19(10.1) 15(7.9) 10( 5.3)
体检组 189 49/140 56±9 22(11.6) 17(9.0) 15( 7.9)
组别 例数 胃息肉[例(%)] 慢性萎缩性胃炎[例(%)] 黏膜下肿物[例(%)] 食管/胃底静脉曲张[例(%)] 幽门螺旋杆菌感染[例(%)]
肝移植组 63 7(11.1) 36(57.1) 3(4.8) 10(15.9) 9(14.3)
慢性乙型肝炎组 189 19(10.1) 60(31.7)a 3(1.6) 3( 1.6)a 101(53.4)a
体检组 189 17( 9.0) 54(28.6)a 4(2.1) 0( 0.0)a 90(47.6)a
表2 乙型肝炎相关性终末期肝病肝移植受者术后发生慢性萎缩性胃炎影响因素分析
组别 例数 年龄(±s，岁) 性别(男/女，例) 术后时间(±s，月) 吸烟史[例(%)] 饮酒史[例(%)] 体质指数(±s，kg/m2)
慢性萎缩性胃炎组 36 58±8a 30/6 37±27 17(47.2) 16(44.4) 23±3
非慢性萎缩性胃炎组 27 51±7 19/8 34±31 8(29.6) 11(40.7) 23±5
组别 例数 糖尿病[例(%)] 高血压[例(%)] 高血脂[例(%)] 末次他克莫司血药浓度(±s，ng/mL) HP阳性[例(%)] 胆汁反流[例(%)]
慢性萎缩性胃炎组 36 11(30.6) 10(27.8) 9(25.0) 4.9±2.6 7(19.4) 3( 8.3)
非慢性萎缩性胃炎组 27 7(25.9) 10(37.0) 9(33.3) 3.4±2.7 2( 7.4) 3(11.1)
表3 乙型肝炎相关性终末期肝病肝移植受者术后发生反流性食管炎影响因素分析
组别 例数 年龄(±s，岁) 性别(男/女，例) 术后时间(±s，月) 吸烟史[例(%)] 饮酒史[例(%)] 体质指数(±s，kg/m2)
反流性食管炎组 13 56±8 10/ 3 34±21 7(53.8) 7(53.8) 25±3
非反流性食管炎组 50 56±6 39/11 35±30 18(36.0) 20(40.0) 23±4
组别 例数 糖尿病[例(%)] 高血压[例(%)] 高血脂[例(%)] 末次他克莫司血药浓度(±s，ng/mL) HP阳性[例(%)] 胆汁反流[例(%)]
反流性食管炎组 13 5(38.5) 7(53.8) 5(38.5) 4.4±1.9 3(23.1) 1( 7.7)
非反流性食管炎组 50 13(26.0) 13(26.0) 13(26.0) 5.4±2.6 6(12.0) 5(10.0)
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