| Objectives To analyze the etiological distribution and clinical characteristics of patients with liver cirrhosis who were hospitalized for the first time in recent 5 years,in order to better prevent,diagnose and treat liver cirrhosis and improve the survival rate of patients.Methods The clinical data of patients with liver cirrhosis diagnosed for the first time in Hebei General Hospital from January 2016 to December 2020 were collected retrospectively,the etiology and complications were analyzed,and the causes of liver cirrhosis complicated with upper gastrointestinal hemorrhage and the constituent ratio of upper gastrointestinal hemorrhage treatment were analyzed.To analyze the difference of plasma D-dimer in different liver function status,ascites and spontaneous bacterial peritonitis(SBP)in patients with liver cirrhosis and its clinical significance.Results 1 The age and sex composition of onset of liver cirrhosis:The youngest age of onset was 22 years old,the maximum age was 94 years old,and the average age was59.39±12.57 years old.Among the 986 patients,the male accounted for 63.7%,the female accounted for 36.3%,and the male:female=1.75:1.2 The main symptoms and signs of patients in the process of seeing a doctor:The main manifestations are abdominal distension,loss of appetite,fatigue,hypersplenism,splenomegaly and so on.3 Top five causes of liver cirrhosis:Including hepatitis B virus infection(431/986,43.7%),alcoholic liver disease(146/986,14.8%),cryptogenic liver disease(124/986,12.6%),autoimmune liver disease(89/986,9.0%),and hepatitis C virus infection(79/986,8.0%).4 The difference of gender in the etiology of liver cirrhosis:The incidence of liver cirrhosis caused by hepatitis C,autoimmune liver disease and cryptogenic liver disease in female patients was significantly higher than that in male patients.The proportion of hepatitis B cirrhosis,alcoholic cirrhosis and hepatitis B complicated with alcoholic liver disease in males was much higher than that in females.5 Complications of liver cirrhosis:the common complications of liver cirrhosis were upper gastrointestinal hemorrhage(34.9%,344/986),primary carcinoma of the liver(30.6%,302/986),cholecystolithiasis(26.6%,262/986),hyponatremia(13.5%,133/986),hepatic encephalopathy(7.7%,76/986),portal thrombosis(7.0%,69/986),and SBP(5.8%,57/986).When admitted to the hospital,there were no complications in 238 cases,only one complication in 279 cases,and two or more complications in 469 cases.The incidence of liver cancer,portal vein thrombosis,hyponatremia,upper gastrointestinal hemorrhage and hepatic encephalopathy in patients with hepatitis B cirrhosis was different from that of alcoholic cirrhosis(χ~2=17.964,P<0.05;χ~2=5.644,P=0.018;χ~2=19.138,P<0.05;χ~2=10.211,P=0.001;χ~2=9.461,P=0.002),but there was no significant statistically difference in liver cancer,portal vein thrombosis,hyponatremia,upper gastrointestinal hemorrhage and hepatic encephalopathy between hepatitis B cirrhosis and hepatitis B virus infection complicated with alcoholic liver cirrhosis(P>0.05).6 Causes and treatment of upper gastrointestinal hemorrhage:There were 344 cases of liver cirrhosis complicated with upper gastrointestinal hemorrhage.The main etiology of hemorrhage were esophagogastric variceal bleeding(257/986,74.4%),esophagogastric variceal bleeding with portal hypertensive gastropathy(59/986,17.2%),and conservative treatment of upper gastrointestinal bleeding in 144 cases(41.9%).Esophagogastroduodeno-scopy treatment was performed in 192 cases(55.8%).7 The influencing factors of liver failure:There were 81 patients with liver failure,including ascites(χ~2=22.425,P<0.05),hepatic encephalopathy(χ~2=81.462,P<0.05),hepatorenal syndrome(χ~2=7.696,P<0.05),hyponatremia(χ~2=56.164,P<0.05)and upper gastrointestinal hemorrhage(χ~2=55.534,P<0.05).8 The relationship between hyponatremia and Child-pugh class:among the patients with liver cirrhosis diagnosed for the first time,the liver function of 249 patients were Child-pugh score A,accounting for25.3%,476 patients were Child-pugh score B,accounting for 48.2%,261patients were Child-pugh score C,accounting for 26.5%.There were significant differences in the incidence of hyponatremia between Child-pugh A and B(χ~2=11.336,P<0.05),Child-pugh grade A and C(χ~2=54.811,P<0.05),Child-pugh B grade and C(χ~2=33.414,P<0.05).9 D-dimer:(1)Median plasma D-dimers were higher than normal in patients with different causes of cirrhosis.(2)There were significant differences in plasma D-dimer levels among different Child-pugh classification,including Child-pugh score C>B>A(P<0.05).(3)The median of plasma D-dimer in ascites group(2.16 mg/L)was significantly higher than that in non-ascites group(0.49 mg/L),and the median of D-dimer in ascites SBP group(4.52 mg/L)was significantly higher than that in non-SBP group(1.98mg/L).Conclusions 1 Liver cirrhosis is more likely to occur in men,and the age of onset is59.39±12.57years old.2 The main symptoms of patients with liver cirrhosis are abdominal distension,loss of appetite,abdominal pain and fatigue.3 The main cause of liver cirrhosis is still hepatitis B virus infection.4 Gender differences in different causes of cirrhosis.Hepatitis B virus infection、alcoholic liver disease、hepatitis B virus infection combined with alcoholic liver disease are more likely to occur in men,while hepatitis C virus infection、autoimmune liver disease and cryptogenic liver disease are more likely to occur in women.5 The main complication of liver cirrhosis is upper gastrointestinal hemorrhage,followed by liver cancer.6 The main cause of upper gastrointestinal hemorrhage is esophagogastric variceal bleeding,and the proportion of patients with upper gastrointestinal hemorrhage treated by endoscopy is much higher than that of conservative treatment.7 Patients with ascites、hepatic encephalopathy、hyponatremia、upper gastrointestinal hemorrhage and hepatorenal syndrome are more likely to develop liver failure.8 The proportion of Child-pugh score B was the highest when the patients with liver cirrhosis were admitted to hospital for the first time,and hyponatremia was closely related to Child-pugh class.9 The level of D-dimer in patients with liver cirrhosis is higher than the normal value,and it is closely related to the severity of liver function injury.If the level of D-dimer is significantly increased,we should pay attention to the occurrence of ascites and SBP.Figure0;Table11;Reference141... |
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