肝硬化者并门静脉血栓形成的危险因素及抗凝治疗对其上消化道出血的影响

Risk factors for portal vein thrombosis in cirrhotic patients and the influences of anticoagulation on esophagogastric variceal bleeding

目的分析肝硬化患者合并门静脉血栓(PVT)的相关因素与独立危险因素,以及抗凝药物治疗对肝硬化并PVT患者食管胃底静脉曲张破裂出血(EGVB)的影响。方法回顾性分析2012年1月至12月间本院确诊的肝硬化患者共239例,根据肝硬化患者有无门静脉血栓(PVT)分为血栓组33例与对照组206例;依据血栓组是否出现EGVB,分为出血组10例和未出血组23例;依据血栓组是否使用抗凝治疗,分为抗凝组10例和未抗凝组23例。观察与比较分析各组与其对照组的危险因素。结果239例肝硬化患者中,血栓组白蛋白(ALB)计数低于对照组(P=0.023),而血小板计数、门静脉主干宽度(MPV)、糖尿病史与脾切除病史等方面均高于对照组(均P<0.01)。非条件logistic回归模型分析发现PLT与MPV是肝硬化合并门静脉血栓形成的独立危险因素(P=0.009,0.001;OR值分别为1.006,16.858)。出血组与未出血组肝硬化并PVT未出血患者的静脉曲张程度与是否行内镜下序贯治疗差异均有统计学意义(P<0.05);抗凝组与未抗凝组观察随访1年发现出血率分别为4/10及26.1%(6/23),两组比较差异无统计学意义(P>0.05)。结论⑴PLT、ALB、MPV、糖尿病及脾切除病史是肝硬化并PVT的危险因素,且PLT、MPV是独立危险因素;⑵肝硬化并PVT患者静脉曲张程度越严重则越易出现出血,对其行内镜下序贯治疗可显著降低肝硬化并PVT患者发生EGVB的风险;⑶肝硬化并PVT患者进行抗凝药物治疗可能不会增加EGVB的发病率.

Objective To investigate the associated factors and the independent risk factors for portal vein thrombosis(PVT)in cirrhotic patients and assess the influences of anticoagulation on esophagogastric variceal bleeding(EGVB)in these patients.Methods From January 2012 to December 2012,239 cirrhotic patients were diagnosed in our hospital.According to the presence or absence of portal vein thrombosis(PVT),they were divided into thrombus group(33 cases)and control group(206 cases).According to the presence or absence of EGVB in thrombus group,they were divided into bleeding group(10 cases)and non bleeding group(23 cases).According to whether anticoagulant therapy was used in thrombus group,they were divided into anticoagulant group(10 cases)and non anticoagulant group(23 cases).The risk factors of each group and its control group were observed and compared.Results The thrombus group had a lower level of the albumin(ALB),higher level of count of platelet(PLT),diameter of main portal vein(MPV),propotion of diabetes prevalence and history of splenectomy compared with the control group(P<0.01).According to unconditional logistic regression analysis,both the PLT and the diameter of MPV were identified as independent risk factors for PVT in cirrhotic patients(P=0.009,0.001;OR=1.006,16.858).There were significant differences in the degree of varicose veins and the proportion of sequential endoscopic treatment between the bleeding group and the control group(P<0.05).Moreover,the group treated with anticoagulant drugs and the group without anticoagulation were followed up and observed for 1 year,which showed no significant changes in the bleeding ratio between two groups[40%(4/10)versus 26.1%(6/23),P>0.05].Conclusions⑴PLT,ALB,MPV,and a history of diabetes or splenectomy are risk factors for cirrhosis combined with PVT,and PLT and MPV are independent risk factors.⑵The incidence of EGVB increased with the increasing severity of esophagogastric varicose vein.The endoscopic variceal sequential treatment can contribute a significant reduction of EGVB in cirrhosis complicated by PVT.⑶Anticoagulant therapy may not raise the incidence of EGVB in cirrhotic patients with PVT.