门静脉血栓对肝硬化患者预后的影响

Impact of portal vein thrombosis on prognosis of patients with liver cirrhosis

目的通过前瞻性队列研究评估门静脉血栓(PVT)对于肝硬化患者预后的影响。方法对2013年6月-2014年6月于北京友谊医院肝病中心诊断为肝硬化并住院治疗的114例患者进行规律随访,根据是否合并PVT将肝硬化患者分为PVT组(n=22)及非PVT组(n=92)。对两组患者进行规律随访,终点事件包括静脉曲张破裂出血、难治性腹水、肝性脑病、肝病相关死亡。正态分布的计量资料两组间比较采用独立样本t检验,非正态分布的计量资料两组间比较采用Mann-Whitney U检验,分类变量比较采用χ~2检验及Fisher精确检验。危险因素分析采用单因素及多因素Cox回归分析。结果 PVT组失代偿事件(χ~2=7.539,P=0.006)、静脉曲张破裂出血(χ~2=5.390,P=0.020)以及难治性腹水(χ~2=19.360,P<0.001)累积发生率均显著高于非PVT组;两组肝性脑病累积发生率比较,差异无统计学意义(χ~2=2.006,P=0.157)。PVT是失代偿事件[风险比(HR)=12.907,95%可信区间(95%CI):2.537~65.658,P=0.002]以及难治性腹水(HR=27.055,95%CI:3.191~229.414,P=0.002)的独立危险因素。PVT组累积生存率低于非PVT组(χ~2=7.112,P=0.008),但在排除了Child-Pugh分级的影响后,两组患者累积生存率差异无统计学意义(Child-Pugh评分≥10的患者比较,χ~2=2.066,P=0.151;Child-Pugh评分<10的患者比较,χ~2=3.068,P=0.080)。结论PVT是肝硬化患者出现失代偿事件以及难治性腹水的独立危险因素,但其并不是肝硬化患者死亡的独立危险因素。

Objective To investigate the impact of portal vein thrombosis（PVT）,a common complication of liver cirrhosis,on the prognosis of patients with liver cirrhosis via a prospective cohort study.Methods The patients who were diagnosed with liver cirrhosis and hospitalized in Liver Research Center,Beijing Friendship Hospital,from June 2013 to June 2014 were enrolled.According to the presence or absence of PVT,they were divided into PVT group（22 patients） and non-PVT group（92 patients）.The patients were followed up regularly,and outcome events included variceal bleeding,refractory ascites,hepatic encephalopathy,and liver disease-related death.The independent samples t-test was used for comparison of normally distributed continuous data between groups,the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups,and the chi-square test and Fisher＇s exact test were used for comparison of categorical data.Univariate and multivariate Cox regression analyses were used to determine risk factors.Results Compared with the non-PVT group,the PVT group had significantly higher cumulative incidence rates of decompensation event（χ^2=7.539,P=0.006）,variceal rupture and bleeding（χ^2=5.390,P=0.02）,and intractable ascites（χ^2=19.360,P0.001）,while there was no significant difference in the cumulative incidence rate of hepatic encephalopathy between the two groups（χ^2=2.006,P=0.157）.PVT was an independent risk factor for decompensation event（HR=12.907,95% CI：2.537-65.658,P=0.002） and intractable ascites（HR=27.055,95% CI：3.191-229.414,P=0.002）.The PVT group had a lower cumulative survival rate than the non-PVT group（χ^2=7.112,P=0.008）,while after the patients were stratified according to Child-Pugh class,there was no significant difference in cumulative survival rate between the two groups for patients with a Child-Pugh score of ≥10（χ^2=2.066,P=0.151） or the patients with Child-Pugh score of10（χ^2=3.068,P=0.08）.Conclusion PVT is an independent risk factor for decompensation event and refractory ascites in patients with liver cirrhosis,but it is not an independent risk factor for death in patients with liver cirrhosis.