肝硬化合并门静脉血栓形成的临床特点及其相关危险因素分析

Clinical features of fiver cirrhosis complicated by portal vein thrombosis and related risk factors

目的分析肝硬化合并门静脉血栓形成（PVT）患者的临床特点及其相关危险因素。方法收集2013年6月至2015年6月诊治的肝硬化合并PVT患者65例（PVT组），选取同阶段肝硬化无PVT患者70例作为对照（无PVT组）。收集患者的一般资料、实验室检查结果、影像学检查结果、临床表现及并发症等情况。比较两组患者的临床特点并筛选出相关危险因素。计量资料两组均数比较采用t检验；计数资料比较采用X2检验；采用非条件logistic回归模型筛选出相应的独立危险因素。结果PVT组与无PVT组患者相比，年龄、性别、民族、病因、白细胞、血小板、国际标准化比值、活化部分凝血酶原时间、纤维蛋白原、血清肌酐、总胆红素、脾静脉内径差异无统计学意义（P值均〉0．05），而D-二聚体[（1．87±1．45）mg／ml与（0．55±0．58）mg／m1]、纤维蛋白原降解产物[FDP（18．57±19．46）μg／m1与（5．45±6．00）μg／m1]、血红蛋白[（99．32±26．73）g／L与（112．64±25．03）g／L]、白蛋白[（28．51±5．19）g／L与（33．07±7．94）g／L]、门静脉内径[（12．53±2．70）mm与（11．17±1．79）mm]、脾脏厚度[（5．12±0．95）cm与（4．56±0．83）cm]、脾脏长度[（15．35土3．21）cm与（13．86±2．82）cm]、Child-Pugh评分[（7．66±2．06）分与（6．93土1．87）分）]差异有统计学意义垆值均〈0．05）。腹泻、肠梗阻、肝肾综合征、肝性脑病的发生率差异无统计学意义护〉0．05），而腹痛（18例与7例）、发热（17例与4例）、食管胃静脉曲张破裂出血（22例与9例）、自发性腹膜炎（24例与12例）的发生率差异有统计学意义垆值均〈0．05）。D-二聚体（017．=4．290，P〈0．01）、门静脉内径（OR=1．294，P〈0．05）是肝硬化合并PVT形成的独立危险因素。结论肝硬化程度重、D-二聚体和FDP水平高、门静脉内径宽的肝硬化患者PVT发病率高。PVT可使肝硬化患者临床症状加重和并发症发生率明显增加。D-二聚体水平增高、门静脉增宽是肝硬化合并PVT形成的独立危险因素。

Objective To investigate the clinical features of patients with liver cirrhosis complicated by portal vein thrombosis （PVT） and related risk factors. Methods A total of 65 patients with liver cirrhosis complicated by PVT who were diagnosed and treated from June 2013 to June 2015 were enrolled as PVT group, and 70 cirrhotic patients without PVT were enrolled as controls （non-PVT group）. The data collected included general information, results of laboratory examination, imaging findings, clinical manifestations, and complications. The clinical features were compared between the two groups, and related risk factors were screened out. Results There were no significant differences between the PVT group and non-PVT group in age, sex, nation, etiology, white blood cell count, platelet count, international normalized ratio, activated partial thromboplastin time, fibrinogen, serum creatinine, total bilirubin, and the diameter of the splenic vein （allP 〉 0.05）, while between these two groups, there were significant differences in D-dimer （1.87±1.45 mg/ml vs 0.55±0.58 mg/ml, P 〈 0.05）, fibrinogen degradation product （FDP） level （18.57±19.46 μg/ml vs 5.45±6.00 μg/ml, P 〈 0.05）, hemoglobin （99.32±26.73 g/L vs 112.64±25.03 g/L, P 〈 0.05）, albumin （28.51±5.19 g/L vs 33.07±7.94 g/L, P 〈 0.05）, the diameter of the portal vein （12.53±2.70 mm vs 11.17±1.79 mm, P 〈 0.05）, spleen thickness （5.12±0.95 cm vs 4.56±0.83 cm, P 〈 0.05）, spleen length （15.35±3.21 cm vs 13.86±2.82 cm, P 〈 0.05）, and Child-Pugh score （7.66±2.06 vs 6.93±1.87, P 〈 0.05）. The two groups showed no significant differences in diarrhea, ileus, hepatorenal syndrome, and hepatic encephalopathy （P 〉 0.05）, but showed significant differences in abdominal pain （18 vs 7 cases, P 〈 0.05）, fever （17 vs 4 cases, P 〈 0.05）, esophageal variceal bleeding （22 vs 9 cases, P 〈 0.05）, and spontaneous peritonitis （24 vs 12 cases, P 〈 0.05）. D-dimer （OR = 4.290, P 〈 0.000） and mean platelet volume （OR = 1.294, P = 0.023） were independent risk factors for PVT in patients with liver cirrhosis. Conclusion Cin＇hotic patients with a high degree of liver cirrhosis, high levels of D-dimer and FDP, and a large diameter of the portal vein tend to have a high incidence rate of PVT. PVT can aggravate the clinical symptoms and significantly increase complications in patients with liver cirrhosis. An increased D-dimer level and a greater width of the main portal vein are independent risk factors for PVT in patients with liver cirrhosis.