肝硬化门静脉血栓形成高危因素的Logistic回归分析

Logistic regression analysis of risk factors for portal vein thrombosis in liver cirrhosis

目的研究肝硬化患者门静脉血栓(PVT)形成的相关危险因素。方法回顾性分析2016年1月至2017年12月314例肝硬化患者病历资料,其中合并PVT者33例,未合并PVT者281例。比较两组患者性别、年龄、肝硬化病因、血常规、生化学指标、凝血功能、门静脉主干内径宽度、门静脉流速及Child-Pugh评分。采用非条件Logistic回归模型筛选出独立危险因素,并绘制ROC曲线,计算AUC以评判各指标的诊断效能。结果单因素分析显示,合并PVT和未合并PVT患者的血小板分别为(70.42±28.96)×10 ^9/L、(85.61±33.24)×10^ 9/L,血浆抗凝血酶-Ⅲ分别为(49.39±17.33)%、(57.31±18.27)%,门静脉流速分别为(12.67±1.19)cm/s、(14.40±1.36)cm/s,D-二聚体分别为(2.09±1.98)mg/L、(0.95±0.52)mg/L,Child-Pugh评分分别为(9.67±1.11)、(8.77±1.03),差异均有统计学意义(均P<0.01)。logistic回归分析显示,抗凝血酶-Ⅲ(OR=0.956,P=0.009)、D-二聚体(OR=6.351,P<0.01)、门静脉流速(OR=0.301,P<0.01)、Child-Pugh评分(OR=2.486,P<0.01)是肝硬化患者发生PVT的重要影响因素,ROC曲线分析显示上述4个因素的AUC分别为0.629、0.786、0.842、0.722。结论门静脉流速减慢、高Child-Pugh评分、高D-二聚体水平、低抗凝血酶-Ⅲ是肝硬化患者PVT的独立危险因素。

Objective To investigate the risk factors for portal vein thrombosis(PVT)in patients with liver cirrhosis.Methods From January 2016 to December 2017,the data of 314 hospitalized patients with liver cirrhosis were retrospectively analyzed.Patients were divided into PVT and control groups according to the occurrence of PVT.Data including age,gender,etiology of cirrhosis,Child-Pugh score,blood cell count,serum biochemical index,blood coagulation function,D-dimer,main portal vein internal diameter and portal vein velocity(PVV)were recorded and analyzed.Non-conditional logistic regression model was used to screen for risk factors.Area under the receiver operator characteristic curve(AUC)was calculated to evaluate the predictive value of each index.Results The incidence of PVT was 10.51%(33/314)in patients with liver cirrhosis.Univariate analysis showed that platelet count(70.42±28.96×10^9/L vs 85.61±33.24×10^9/L,P=0.012),antithrombinⅢ(AT-Ⅲ)(49.39±17.33%vs 57.31±18.27%,P=0.009),PVV(12.67±1.19 cm/s vs 14.40±1.36 cm/s,P<0.001),D-dimer(2.09±1.98 mg/L vs 0.95±0.52 mg/L,P=0.003)and Child-Pugh score(9.67±1.11 vs 8.77±1.03,P<0.001)were correlated with the development of PVT.Non-conditional logistic regression analysis indicated that AT-Ⅲ(OR=0.956,P=0.009),D-dimer(OR=6.351,P<0.001),PVV(OR=0.301,P<0.001),and Child-Pugh score(OR=2.486,P<0.001)were independent risk factors for PVT in patients with liver cirrhosis.The AUC of the 4 factors was 0.629,0.786,0.842 and 0.722,respectively.Conclusion Low PVV,high Child-Pugh score,high D-dimmer level,and low AT-Ⅲare independent risk factors for PVT in patients with liver cirrhosis.