肝硬化上消化道出血患者并发门静脉血栓形成的危险因素

Risk factors for portal vein thrombosis in patients with liver cirrhosis and upper gastrointestinal bleeding

目的探讨肝硬化上消化道出血患者发生门静脉血栓(portal vein thrombosis,PVT)形成的危险因素。方法肝硬化上消化道出血患者412例,依据超声检查结果分为无PVT组274例,PVT组138例,比较2组一般资料、生化检查结果及临床病理特征,logistic回归分析肝硬化上消化道出血患者并发PVT形成的独立危险因素。结果无PVT组Child-Pugh肝功能分级A级比率(30.66%)高于PVT组(10.14%)(P<0.05),Child-Pugh肝功能分级B、C级比率(33.94%、35.40%)低于PVT组(47.83%、42.03%)(P<0.05),腹腔积液、腹腔积液感染、肝性脑病发病率(54.38%、28.83%、14.60%)及肝硬化家族史比率(12.04%)低于PVT组(88.40%、58.70%、31.16%、94.93%)(P<0.05);无PVT组血小板计数[(97.44±62.27)×109/L]、谷丙转氨酶[(69.09±47.72)u/L]、谷草转氨酶[(64.97±59.95)u/L]低于PVT组[(125.93±105.67)×109/L、(120.59±80.71)u/L、(300.04±156.83)u/L](P<0.05),胆碱酯酶[(3 506.60±1 978.94)u/L]高于PVT组[(2 932.87±1 522.48)u/L](P<0.05),凝血酶时间[(14.27±4.67)s]较PVT组[(12.88±3.67)s]长(P<0.05),门静脉内径[(12.84±1.46)mm]、脾静脉内径[(8.76±2.22)mm]、脾脏厚度[(41.97±9.89)mm]较PVT组[(17.38±2.47)、(9.88±2.33)、(47.12±8.49)mm]小(P<0.05);2组年龄,性别比例,食管胃底静脉曲张比率,以及红细胞、血红蛋白、白细胞计数、白蛋白、总胆红素、凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原水平比较差异均无统计学意义(P>0.05);logistic回归分析结果显示,血小板计数>300×109/L(OR=1.020,95%CI:1.003~1.036,P=0.020)、门静脉内径>10 mm(OR=11.098,95%CI:3.533~34.861,P<0.001)、Child-Pugh肝功能分级C级(OR=2.872,95%CI:0.385~21.423,P=0.036)是肝硬化上消化道出血患者并发PVT的独立危险因素。结论血小板计数增高、门静脉内径增宽、肝功能Child分级C级是肝硬化上消化道出血患者并发PVT的独立危险因素。

Objective To investigate the risk factors for portal vein thrombosis（PVT）in patients with liver cirrhosis and upper gastrointestinal bleeding.Methods Totally 412 patients with liver cirrhosis and upper gastrointestinal bleeding were divided into no-PVT group（n=274）and PVT group（n=138）according to the ultrasonographic results.The clinical data,laboratory results and clinicopathologic features were compared between two groups.The independent risk factors for portal vein thrombosis were evaluated by logistic regression analysis method.Results The proportion of Child-Pugh grade A was significantly higher in no-PVT group（30.66%）than that in PVT group（10.14%）（P〈0.05）,and the proportions of Child-Pugh grade B and C were significantly lower in no-PVT group（33.94%,35.40%）than those in PVT group（47.83%,42.03%）（P〈 0.05）.The incidences of ascites,ascites infection and hepatic encephalopathy as well as the rate of family history of cirrhosis were significantly lower in no-PVT group（54.38%,28.83%,14.60%,12.04%）than those in group PVT（88.40%,58.70%,31.16%,94.93%）（P〈0.05）.The levels of platelet（（97.44±62.27）×109/L）,glutamic-pyruvic transaminase（（69.09±47.72）u/L）and glutamic-oxaloacetic transaminase（（64.97±59.95）u/L）in no-PVT group were significantly lower than those in PVT group（（125.93±105.67）×109/L,（120.59±80.71）u/L,（300.04±156.83）u/L）（P〈0.05）.Cholinesterase was significantly higher in no-PVT group（（3 506.60±1 978.94）u/L）than that in PVT group（（2 932.87±1 522.48）u/L）（P〈0.05）.Thrombin time was significantly longer in no-PVT group（（14.27±4.67）s）than that in PVT group（（12.88±3.67）s）（P〈0.05）.The internal diameter of portal vein（（12.84±1.46）mm）and internal diameter of splenic vein（（8.76±2.22）mm）were significantly shorter,and the thickness of spleen（（41.97±9.89）mm）was significantly thinner in no-PVT group than those in PVT group（（17.38±2.47）,（9.88±2.33）,（47.12±8.49）mm）（P〈0.05）.There were no significant differences in the age,sex ratio,ratio of esophageal and gastric fundus varices,and the levels of red blood cell,hemoglobin,white blood cell,albumin,total bilirubin,prothrombin time,activated partial thromboplastin time and fibrinogen between two groups（P〉0.05）.Logistic regression analysis showed that high platelet（〉300×109/L）（OR=1.020,95%CI：1.003-1.036,P=0.020）,long portal vein diameter（〉10 mm）（OR=11.098,95%CI：3.533-34.861,P=0.000）and Child-Pugh grade C（OR=2.872,95%CI：0.385-21.423,P=0.036）were the independent risk factors for portal vein thrombosis in patients with liver cirrhosis and upper gastrointestinal bleeding.Conclusion High platelet,long diameter of portal vein and Child-Pugh grade C are the independent risk factors for portal vein thrombosis in patients with liver cirrhosis and upper gastrointestinal bleeding.