肝硬化合并门静脉血栓形成的临床特点

Clinical characteristic of cirrhotic patients with portal vein thrombosis

目的分析肝硬化患者合并门静脉血栓形成(PVT)的临床特点及危险因素,了解该类患者药物性预防措施是否有效。方法 2008年1月至2011年3月各种原因的肝硬化住院患者共339例,将其分为两组,分别为肝硬化合并有门静脉血栓形成组及未合并有门静脉血栓组。记录患者年龄、性别、凝血酶原时间(PT)、总胆红素、白蛋白、肝硬化的病因、Child-Pugh评分以及是否存在导致PVT的高危因素,并且记录患者发病前是否应用阿司匹林或低分子肝素等药物预防治疗。对上述两组患者的数据进行统计学分析。结果在339例患者当中,合并有门静脉血栓形成的38例,占11.21%。肝硬化合并PVT患者与对照组相比,在年龄、性别、血小板计数、PT及总胆红素水平等方面无明显差异。肝硬化合并PVT患者与对照组相比,在Child-Pugh评分及白蛋白数值之间存在明显差异,两组相比,P<0.05。且肝硬化患者合并PVT组死亡率远远超过对照组,两者相比P<0.05。在应用阿司匹林或低分子肝素预防的肝硬化患者中,出现PVT的概率并无明显下降,且出现消化道出血的概率明显上升。结论 Child-Pugh分级是肝硬化合并PVT形成的危险因素。应用低分子肝素或阿司匹林等药物预防PVT,疗效并不理想。

Objective To investigate the characteristic of portal vein thrombosis（PVT） in cirrhotic patients, and examine the practice of portal vein thrombosis （PVT） prophylaxis among cirrhotic patients. Methods A retrospective study was performed in Peking university Shenzhen hospital. We included all adult patients admitted to the hospital with a diagnosis of liver cirrhosis from January 2008 to March 2011. We divided patients into two groups, cirrhotic patients without PVT and cirrhotic with PVT. For each patient, the following information was collected： age, gender, prothrombin time （PT）, bilirubin, albumin, platelet counts, etiology of liver cirrhosis, Child-Pugh score, PVT risk factors and use of pharmacologic prophylaxis. Results We included 339 cirrhotic patients, 38 patients （1l. 21%） developed PVT. Both groups were similar with respect to baseline characteristics, including bilirubin, creatinine and coagulation profile. The etiology of liver cirrhosis and the prevalence of hepatocellular carcinoma were similar in both groups. But there was a trend toward a higher Child- Pugh score in cirrhotic patients with PVT. Conclusions Child-Pugh ratings of cirrhosis patients is a risk factor for PVT. The utilization of PVT prophylaxis is suboptimal.