肝硬化合并门静脉血栓形成的相关危险因素分析

Analysis of risk factors for portal vein thrombosis in liver cirrhosis patients

目的探讨肝硬化合并门静脉血栓形成的相关危险因素。方法回顾性分析2013年6月至2017年6月在新疆医科大学第一附属医院218例肝硬化患者的临床资料,患者中109例为肝硬化并门静脉血栓患者,109例为肝硬化无门静脉血栓的患者。分析两组患者的一般资料、临床表现、并发症、实验室检查及影像学检查资料的结果,组间计量资料比较使用t检验,计数资料比较采用χ~2检验,应用非条件Logistic回归模型进行多因素分析、筛选出独立危险因素。结果门静脉血栓的发生与Child-Pugh分级(χ~2=20.293,P<0.01)、脾脏切除术(χ~2=11.869,P<0.01)、门静脉主干内径宽度(t=3.125,P<0.01)、脾脏的厚度(t=2.283,P=0.024)、血红蛋白(t=-3.751,P<0.01)、白蛋白(t=-3.924,P<0.01)、D-二聚体(t=5.861,P<0.01)、纤维蛋白降解产物(t=3.110,P<0.01)有关,不受性别、年龄、族别、吸烟、病因、白细胞计数、血小板计数、凝血酶原时间、国际标准化比值、部分凝血活酶时间、纤维蛋白原、胱抑素、血肌酐、总胆红素、直接胆红素、丙氨酸转氨酶、碱性磷酸酶、谷胺酰转肽酶、脾静脉内径宽度、脾脏的长径、高血压、糖尿病的影响。两组患者发生腹泻、肝性脑病、肝肾综合征差异无统计学意义(均P>0.05),腹痛(χ~2=4.598)、发热(χ~2=7.72)、消化道出血(χ~2=18.435)、原发性腹膜炎(χ~2=16.987),差异有统计学意义(均P<0.05)。D-二聚体、门静脉主干内径宽度、Child-Pugh分级、脾脏切除术是肝硬化患者PVT形成的独立危险因素(OR=0.686、0.161、3.193、9.515),均P<0.05)。结论 D-二聚体、门静脉主干内径宽度、Child-Pugh分级、脾脏切除术是肝硬化患者PVT形成的独立危险因素,肝硬化合并PVT可以使患者的临床症状加重,并发症发生率增加。

Objective To investigate clinical characteristics of liver cirrhosis patients with portal vein thrombosis(PVT)and the related risk factors.Methods Clinical data of 218 patients with liver cirrhosis from June 2013 to June 2017 in our hospital were retrospectively analyzed,including 109 cases with PVT and 109 cases without PVT.General information,clinical manifestations,complications,laboratory examinations and imaging data were analyzed.Measurement data were compared by t-test and enumeration data were by chi-square test.Unconditional logistic regression model was applied for analyzing independent risk factors of PVT in liver cirrhosis patients.Results There were no differences in age,gender,nation,smoking,etiology,white blood cell count,platelet count,prothrombin time,international normalized ratio,activated partial prothrombin,fibrinogen,creatinine,cystatin C,total bilirubin,direct bilirubin,alanine aminotransferase,gamma glutamyl transpeptidase,alkaline phosphatase,length of spleen and width of splenic vein between PVT group and non-PVT group.However,Child-Pugh score(χ2=20.293,P=0.0001),splenectomy(χ2=11.869,P=0.001),the width of portal vein(t=3.125,P=0.002),width of spleen(t=2.283,P=0.024),hemoglobin(t=-3.751,P=0.000),albumin(t=-3.924,P=0.000),D-dimer(t=5.861,P=0.000)and fibrin degradation products(t=3.110,P=0.002)were significantly different between PVT group and non-PVT group.Occurrence of diarrhea,hepatic encephalopathy and hepatorenal syndrome showed no significant difference between two groups(P>0.05),but abdominal pain(χ2=4.598,P=0.032),fever(χ2=7.72,P=0.005),upper gastrointestinal bleeding(χ2=18.435,P=0.0001)and spontaneous peritonitis(χ2=16.987,P=0.000)were significantly different between two groups(P<0.05).Conclusion D-dimer,width of portal vein,Child-Pugh score and splenectomy are independent risk factors for PVT in liver cirrhosis patients(OR=0.686,0.161,3.193 and 9.515;P=0.0001,0.007,0.021 and 0.007,respectively).PVT in liver cirrhosis patients would aggravate clinical symptoms and increase incidence of complications.