肝硬化门静脉血栓160例的临床特点和治疗分析

Clinical features and treatment of 160 cases of liver cirrhosis with portal vein thrombosis

目的分析肝硬化合并门静脉血栓（PVT）患者的临床特征，探讨PVT形成的高危因素，为预防及早期治疗PVT提供参考。方法选取2012年1月至2017年8月重庆医科大学附属第二医院肝硬化合并PVT的住院患者160例为PVT组，排除其他因素继发的PVT；选取同期不合并PVT的肝硬化住院患者250例为对照组。根据患者是否行脾切除术分为有脾切除史组和无脾切除史组。收集血红蛋白、血小板计数、PT、国际标准化比值（INR）、凝血酶原活动度等可能与PVT形成相关的危险因素资料，采用t检验、卡方检验、非参数秩和检验分析上述指标在PVT组和对照组间的差异，采用单因素和多因素二元logistic回归分析筛选PVT形成的危险因素。结果PVT组年龄为（54.5±11.4）岁，大于对照组的（51.8±11.9）岁，差异有统计学意义（t＝2.29，P＝0.02）。多因素二元logistic回归分析显示，血红蛋白、血小板计数、PT和INR为PVT形成的独立危险因素（P均〈0.05）；PVT组Child-Pugh C级比例高于对照组[16.2%（26/160）比4.4%（11/250）]，差异有统计学意义（χ^2＝16.60，P〈0.01）。PVT组中27.5%（44/160）的患者有脾切除史，对照组中8.4%（21/250）的患者有脾切除史，两组脾切除史比例差异有统计学意义（χ^2＝26.70，P〈0.01）。有脾切除史患者血小板计数高于无脾切除史患者[（176.2±98.7）×10^9/L比（78.3±57.8）×10^9/L]，差异有统计学意义（t＝11.08，P〈0.01）。PVT组并发症发生率高于对照组[45.0%（72/160）比10.0%（25/250）]，差异有统计学意义（χ^2＝66.17，P〈0.05）。PVT治疗和不治疗患者消化道出血率和病死率比较[分别为25.6%（11/43）比23.8%（10/42），18.6%（8/43）比31.0%（13/42）]，差异均无统计学意义（P均〉0.05）。结论血红蛋白降低、血小板增高、PT延长、INR增高、Child分级是PVT形成的高危因素。脾切除术后血小板增加是PVT形成的独立危险因素。

ObjectiveTo analyze the clinical characteristics of patients with liver cirrhosis complicated with portal vein thrombosis （PVT） and to explore the high risk factors of PVT formation for the prevention and early treatment of PVT.MethodsFrom January 2012 to August 2017, at the Second Hospital Affiliated to Chongqing Medical University, 160 hospitalized liver cirrhosis patients complicated with PVT were selected as PVT group and secondary PVT caused by other factors were excluded. At the same time, 250 patients with liver cirrhosis without PVT were enrolled as the control group. According to the history of splenectomy, the patients were divided into splenectomy group and non-splenectomy group. The risk factors correlated with the formation of PVT such as hemoglobin, platelet count, prothrombin time （PT）, international normalized ratio （INR） and prothrombin activity were collected. T test, chi-square test and non-parameter rank test were performed for the comparison of above indexes between PVT group and control group. Single factor analysis and multifactor logistic regression were used to analyze the risk factors of PVT formation.ResultsThe average age of patients in PVT group （（54.5±11.4） years） was significantly older than that in control group （（51.8±11.9） years, t=2.29, P=0.02）. The results of multifactor logistic regression analysis showed that hemoglobin, platelet count, PT and INR were risk factors of PVT formation （all P〈0.05）. The proportion of patients with Child-Pugh class C cirrhosis in PVT group was higher than that in control group （16.2%, 26/160 vs. 4.4%, 11/250）, and the difference was statistically significant （χ^2=16.60, P〈0.01）. In PVT group, 27.5% （44/160） patients had a history of splenectomy, and 8.4% （21/250） patients of the control group had a history of splenectomy, and the difference between two groups was statistically significant （χ^2=26.70, P〈0.01）. The platelet counts of patients with splenectomy were higher than those of patients without splenectomy （（176.2±98.7）×10^9/L vs. （78.3±57.8）×10^9/L）, and the difference was statistically significant （t=11.08, P〈0.01）. The incidence of complications in PVT group was much higher than that in control group （45.0%, 72/160 vs. 10.0%, 25/250, χ^2=66.17, P〈0.05）. There were no statistically significant differences in the incidence of gastrointestinal bleeding and mortality between PVT treatment group and non-treatment group （25.6%, 11/43 vs. 23.8%, 10/42; 18.6%, 8/43 vs. 31.0%, 13/42, respectively; both P〉0.05）.ConclusionsDecreased hemoglobin, increased platelet count, prolonged PT, increased INR and Child-Pugh classification are the risk factors for PVT formation. Increased platelet after splenectomy is an independent risk factor for PVT formation.