肝硬化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

目的探讨肝硬化患者门静脉血栓(PVT)形成的相关危险因素。方法回顾性分析1 670例肝硬化患者病例资料,将其中217例发生PVT者纳入PVT组,随机选择250例未发生PVT者纳入非PVT组。记录两组患者的一般资料、实验室检查结果、临床表现及并发症、手术及药物应用史情况,运用单因素分析和多因素分析方法寻找肝硬化PVT发生的相关危险因素。结果 1 670例肝硬化患者中13%并发PVT,肝功能分级以Child-Pugh B和C级为主。单因素分析显示,两组在D-二聚体、Hb、TBiL、重度食管静脉曲张、脾切除手术、止血药物及心得安使用方面差异均有统计学意义(P<0.05)。多因素非条件Logistic回归分析显示,重度食管静脉曲张(OR=6.918,P=0.018)、脾切除手术(OR=4.281,P=0.007)、D-二聚体升高(OR=5.007,P<0.001)为肝硬化PVT形成的独立危险因素。结论止血药物、心得安、D-二聚体升高、重度食管静脉曲张、脾切除术均可能与肝硬化PVT的形成有关,其中重度食管静脉曲张、脾切除术、D-二聚体升高为肝硬化PVT形成的独立危险因素。

Objective To investigate the risk factors of portal vein thrombosis (PVT)in cirrhotic patients.Methods The clinical data of 1670 hospitalized cirrhotic patients were retrospectively analyzed,of whom 217 with PVT were classified into the PVT group,while 250 without PVT were randomized into the non-PVT group.The general information,laboratory results,clinical manifestations,complications,surgery and drug administration history of the two groups were recorded.The risk factors of PTV were analyzed with univariate analysis and multivariate Logistic regression analysis.Results Of the 1670 cirrhotic patients,13% developed PVT,whose liver function was classified as Child-Pugh B and C.Univariate analysis showed significant differences in d-dimer,hemoglobin (Hb),total bilirubin (TBiL),severe esophageal varices,previous splenectomy,hemostatic drugs and propranolol between the two groups. Multivariate Logistic regression analysis showed that severe esophageal varices (OR =6.918,P =0.018),previous splenectomy (OR=4.281,P=0.007)and increase of d-dimer (OR=5.007,P<0.001)were independent risk factors of PVT.Conclusion Hemostatic drugs,propranolol,increase of d-dimer,severe esophageal varices,previous splenectomy may be associated with the formation of PVT in cirrhotic patients.Severe esophageal varices,previous splenectomy and increase of d-dimer are independent risk factors of PVT.