Clinical Analysis Of 199 Cases Of The Hepatic Cirrhosis With Gallbladder Wall Thickening

Because of the anatomical position and the interaction of physiologic function, the patients with hepatic cirrhosis often company with the disease of gallbladder. We can see chronic cholecystitis,acute cholecystitis,cholecystolithiasis and polypi in the patients with hepatic cirrhosis.While gallbladder wall thickening (GBWT) is also one of the most frequent gallbladder alteration accompanied with the hepatic cirrhosis. It is important to realize the nosogenesis of GBWT in the patients with liver cirrhosis, because GBWT correlates with the level of seralbumin, portal hypertension and liver function.And also, GBWT has clinical significance in early prediction of portal hypertension and the liver function.Objective: To analyze the GBWT cases with cirrhosis. The clinical characteristics, the correlation between the degree of GBWT and seralbumin, parameters related to portal hypertension, Child- Pugh grading and Child- Pugh score are supposed to be analyzed as the references of the early prediction of portal hypertension and the liver function.Methods: The retrospective analysis covered 199 cases diagnosed cirrhosis combined with the GBWT in our hospital from Jan 2003 to Jan 2007.All 199 cases were divided into three groups according to the degree of GBWT diagnosed by Doppler ultrasound: small thickness (S), midrange thickness (M), large thickness (L). Albumin(ALB),portal vein diameter (PV),splenic vein diameter (SV) were recorded, Child-Pugh grading (CPG),Child-Pugh score (CPS)were calculated for all patients. To observe: (1) The relationship between the degree of GBWT and sex, age of all patients, and their etiopathogenisis. (2) The constituent ratio of Child-Pugh's class A, B, C in S, M,L groups; the dependablity between Child-Pugh grading and GBWT; (3) The difference of ALB and CPS in S, M, L groups; the relationship between the degree of GBWT and ALB, CPS; (4) The difference of PV, SV in S, M, L groups; the relationship between the degree of GBWT and PV,SV.Results: (1) Of 1100 cases of liver cirrhosis, 199 cases combined with the GBWT which occupied 18.09%.Among them, the number of male was 139(69.85%) while female was 60 (30.15%). The youngest age was 27, the eldest age was 79, and mean age was 52.6±11.8. 86 cases in small thickness group (43.2%), average age was 52.7±11.6 years old, the ratio of male to female was 1:0.46, 71 cases in midrange thickness group (35.7%), average age was 53.6±12.7 years old, the ratio of male to female was 1:0.54, 42 cases in large thickness group (21.1%), average age was 50.6±10.6 years old, the ratio of male to female was 1:0.24. There are no statistical difference on sex and age among S, M, L groups.The cause composition were as follows: posthepatic cirrhosis of chronic hepatitis B (92cases, 46.23%), posthepatic alcoholic cirrhosis (45 cases, 22.61%), posthepatic cirrhosis of chronic hepatitis C (37cases, 18.59%), cryptogenic cirrhosis (4cases, 2.01%). (2) There is positive correlation between CPG and GBWT. The constituent ratio of Child-Pugh's class A, B, C in three groups: class A accounts 44.19%, class B accounts 46.51%, class C accounts 9.30% in S group, the counterparts in M group are 23.94%, 60.56%, 15.50%, and in L group are 21.43%, 45.24%, 33.33%. (3) All parameters are different among S, M, L groups: ALB (P<0.01), CPS (P<0.01), PV (P<0.01), SV (P<0.01). Further comparisons show that ALB, PV, SV are more different among three groups (P<0.01); CPS is more different between S and M group, S and L group (P<0.01), less different between M and L group (P<0.05). There is negative correlation between ALB and GBWT (R=-0.530, P<0.0001), and positive correlation between GBWT and CPS (R=0.372, P<0.0001), GBWT and PV (R=0.554, P<0.0001), GBWT and SV (R=0.528, P<0.0001).Conclusions: (1) The incidence of GBWT combined with the cirrhosis is comparatively high, accounts 18.09%. (2) The sex, age of cirrhotic patients are not associated with the degree of GBWT. (3) There are positive correlation between CPG and GBWT ,CPS and GBWT and negative correlation between ALB and GBWT. (4) PV and SV can be considerd as the indirect reaction of portal venous pressure, and they vary with GBWT. So there is positive correlation between GBWT and portal venous pressure.