肝硬化患者门静脉高压性结肠病的特征及其危险因素

Characteristics and risk factors of portal hypertensive colopathy in patients with liver cirrhosis

摘要:

背景与目的 门静脉高压性结肠病（PHC）是肝硬化相关门静脉高压的常见并发症之一，可能导致消化道出血，但其发病机制尚不明确，国内系统研究较少。为提高临床认识，本研究旨在分析肝硬化患者结肠镜表现的特征，并探讨其与临床相关因素的关系。方法 回顾性分析2020年7月—2024年12月在邢台市人民医院接受结肠镜检查的99例肝硬化患者的肠镜、胃镜及临床资料，比较PHC组与非PHC组患者在性别、肝功能Child-Pugh分级、血小板水平、腹水、肝性脑病等方面的差异，并行多因素Logistic回归分析以识别PHC的独立危险因素。同时将该人群与同期参加国家结直肠癌筛查的444例人群进行结直肠病变检出率对比。结果 99例肝硬化患者中PHC检出率为32.32%，腺瘤性息肉28.28%，结直肠癌3.03%，仅37.37%无异常发现。未见结肠镜相关严重并发症。PHC组患者中男性比例明显高于非PHC组（78.13% vs. 50.75%，P=0.009），肝功能Child-Pugh分级B/C级占比明显高于非PHC组，血小板计数在PHC组中明显降低（均P<0.05）。腹水及肝性脑病发生率在两组之间差异无统计学意义（P>0.05）。多因素分析显示，男性（OR=3.307，95% CI=1.219~8.971）、肝功能Child-Pugh分级B/C级（OR=2.867，95% CI=1.046~7.861）是PHC的独立危险因素。与国家筛查队列相比，本组肝硬化患者腺瘤检出率无明显差异（28.28% vs. 25.00%，P=0.499），结直肠癌检出率略高，但差异无统计学意义（3.03% vs. 0.68%，P=0.135）。结论 肝硬化患者结肠镜异常率高，PHC及腺瘤性息肉较常见。建议无禁忌证的肝硬化患者，尤其是男性、肝功能Child-Pugh分级B/C级患者应常规接受结肠镜检查，以提高PHC及癌前病变的早期识别率，减少下消化道出血及肿瘤漏诊风险。

Abstract:

Background and Aims Portal hypertensive colopathy (PHC) is a common complication of portal hypertension in patients with liver cirrhosis. It may lead to gastrointestinal bleeding, yet its underlying pathogenesis remains unclear, and systematic research in China is limited. This study aimed to analyze the colonoscopic features in cirrhotic patients and to explore their associations with relevant clinical factors.Methods A retrospective analysis was conducted on 99 cirrhotic patients who underwent colonoscopy at Xingtai People's Hospital between July 2020 and December 2024. Colonoscopy, gastroscopy, and clinical data were reviewed. Differences between patients with PHC and those without were compared in terms of sex, Child-Pugh classification, platelet count, presence of ascites, and hepatic encephalopathy. Multivariate logistic regression was used to identify independent risk factors for PHC. Additionally, colorectal lesion detection rates were compared with those of a contemporaneous cohort of 444 participants undergoing national colorectal cancer (CRC) screening at the same center.Results Among the 105 patients with cirrhosis, the detection rates of PHC, adenomatous polyps, and CRC were 32.32%, 28.28%, and 3.03%, respectively, while only 37.37% had no abnormal findings. No serious colonoscopy-related complications were observed. The proportion of males in the PHC group was significantly higher than in the non-PHC group(78.13% vs. 50.75%, P=0.009). The PHC group also showed significantly higher rates of Child-Pugh class B/C, and lower platelet count (all P<0.05). There was no statistically significant difference in the incidence of ascites and hepatic encephalopathy between the two groups (P>0.05).Multivariate analysis identified that male gender (OR=3.307, 95% CI=1.219-8.971) and Child-Pugh class B/C (OR=2.867, 95% CI=1.046-7.861) were independent risk factors for PHC. Compared to the CRC screening cohort, cirrhotic patients had a similar adenoma detection rate (28.28% vs. 25.00%, P=0.499), and a slightly higher colorectal cancer detection rate that did not reach statistical significance (3.03% vs. 0.68%, P=0.135).Conclusion Colonoscopy revealed a high rate of abnormalities in cirrhotic patients, with PHC and adenomatous polyps being the most common findings. Routine colonoscopy is recommended for cirrhotic patients without contraindications, especially males, and patients with Child-Pugh class B/C, to facilitate early detection of PHC and precancerous lesions, thereby reducing the risk of lower gastrointestinal bleeding and missed diagnoses of malignancy.