肝硬化患者门静脉血栓形成的相关危险因素

Risk factors of portal vein thrombosis in patients with liver cirrhosis

目的:研究肝硬化患者门静脉血栓(portal vein thrombosis,PVT)形成的相关危险因素.方法:2006-2007年我院确诊的肝炎和酒精性肝硬化患者90例,其中23例肝硬化PVT患者作为血栓组,67例肝硬化非血栓患者作为对照组.采用凝固法检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和纤维蛋白原(Fib),发色底物法检测抗凝血酶-Ⅲ(AT-Ⅲ),酶联免疫吸附双抗体夹心法检测蛋白-C(PC)、蛋白-S(PS)、D-二聚体(d-dimer)、组织纤溶酶原激活物剂(t-PA)和组织纤溶酶原激活物抑制剂-1(PAI-1).将门静脉血栓形成的相关因素纳入研究,进行统计学分析.结果:d-dimer升高是肝硬化PVT形成的危险因素(OR=13.236,95%CI:2.345-74.721),PC和AT-Ⅲ升高是肝硬化PVT形成的保护因素(OR=0.242,95%CI:0.08-0.727;OR=0.917,95%CI:0.841-0.999).研究未能提示性别、肝功能Child-Pugh分级和APTT等止凝血指标是PVT形成的危险因素.结论:d-dimer升高是肝硬化PVT形成的危险因素,PC和AT-Ⅲ升高是肝硬化PVT形成的保护因素.

AIM： To determine risk factors of portal vein thrombosis （PVT） in liver cirrhosis patients. METHODS： Ninety patients diagnosed as hep-atitis or non-alcoholic liver cirrhosis from 2006 to 2007 in our hospital were reviewed, includ-ing 23 liver cirrhosis cases with PVT in throm-bosis group and 67 without PVT in the control group. A coagulation method was used to mea-sure prothrombin time （PT）, activated partial prothrombin time （APTT） and fibrinogen （Fib）; hair color substrate was used to detect anti-thrombin-Ⅲ （AT-Ⅲ）; ELISA was used to detect protein C （PC）, protein S （PS）, d-dimer, t-PA and PAI-1. Using an analyzer and following manufacturer instructions, a series of hemostat-ic indexes were performed on 90 LC patients with and without PVT. SPSS software was used for statistic analysis. RESULTS： Logistic regression model showed that the increased d-dimer was a risk factor （OR= 13.236, 95% CI： 2.345-74.721） and the increased PC and AT-Ⅲ were the protective factors in PVT development （OR = 0.242, 95% CI： 0.08-0.727; OR = 0.917, 95% CI： 0.841-0.999）. No differences were found in gender, Child-Pugh scores and APTT et al. CONCLUSION： The increased d-dimer was the risk factor for liver cirrhosis patients with PVT while PC and AT-Ⅲ were the protective factors.