肝硬化食管静脉曲张患者门静脉血栓形成的危险因素分析

Risk factors of portal vein thrombosis in cirrhotic patients with esophageal varices

目的旨在识别肝硬化食管静脉曲张患者中门静脉血栓(PVT)形成的独立危险因素,并建立一个预测PVT发生风险的列线图。方法回顾性分析2013年12月—2018年12月于山东大学附属省立医院就诊的283例肝硬化食管静脉曲张患者资料,根据影像学检查将其分为PVT组(n=119)和非PVT组(n=164)。计量资料两组间比较采用t检验或Mann-Whitney U检验,计数资料两组间比较采用χ2检验。利用多因素logistic回归分析筛选独立危险因素,基于多因素回归结果建立并检验列线图,应用C指数(C-index)、校准曲线评价其性能。结果单因素分析显示,PVT组在Child-Pugh分级(χ^2=9.388,P=0.009)、脾切除史(χ^2=26.805,P<0.001)、WBC(Z=-2.248,P=0.025)、PLT(Z=-3.323,P=0.001)、D-二聚体水平(Z=-6.236,P<0.001)及脾脏厚度(Z=-2.432,P=0.015)方面高于非PVT组,而TG水平低于非PVT组(Z=-4.150,P<0.001)。多因素分析显示,TG水平(OR=0.441,95%CI:0.190~0.889)、D-二聚体水平升高(OR=1.151,95%CI:1.041~1.272)、PT延长(OR=1.160,95%CI:1.025~1.313)、有脾切除史(OR=2.933,95%CI:l.164~7.389)是肝硬化食管静脉曲张患者PVT形成的独立风险因素。基于多因素回归结果,建立了列线图,其C指数值为0.745,校准曲线显示PVT发生的观测值和预测值之间有较好的一致性。结论TG水平降低、有脾切除史、D-二聚体水平升高、PT延长是肝硬化食管静脉曲张患者PVT形成的独立危险因素,基于此所建立的列线图,为临床医生评估PVT形成风险提供了一个定量、直观的工具。

Objective To investigate the risk factors for portal vein thrombosis(PVT)in cirrhotic patients with esophageal varices,and to establish a nomogram for predicting the risk of PVT.Methods A retrospective analysis was performed for the clinical data of 283 cirrhotic patients with esophageal varices who attended Shandong Provincial Hospital Affiliated to Shandong University from December 2013 to December 2018,and according to imaging findings,the patients were divided into PVT group with 119 patients and non-PVT group with 164 patients.The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups.A multivariate logistic regression analysis was used to screen out independent risk factors;a nomogram was established and validated based on the results of the multivariate logistic regression analysis,and C-index and calibration curve were used to evaluate its performance.Results The univariate analysis showed that compared with the non-PVT group,the PVT group had significantly higher Child-Pugh class(χ^2=9.388,P=0.009),proportion of patients with a history of splenectomy(χ^2=26.805,P<0.001),white blood cell count(Z=-2.248,P=0.025),platelet count(Z=-3.323,P=0.001),D-dimer(Z=-6.236,P<0.001),and spleen thickness(Z=-2.432,P=0.015)and a significantly lower level of triglyceride(TG)(Z=-4.150,P<0.001).The multivariate logistic regression analysis showed that a reduction in TG(odds ratio[OR]=0.441,95%confidence interval[CI]:0.190-0.889),an increase in D-dimer(OR=1.151,95%CI:1.041-1.272),prolonged prothrombin time(PT)(OR=1.160,95%CI:1.025-1.313),and a history of splenectomy(OR=2.933,95%CI:1.164-7.389)were independent risk factors for PVT in cirrhotic patients with esophageal varices.In addition,a nomogram was established based on the results of the multivariate regression analysis,with a C-index of 0.745,and the calibration curve showed good consistency between the observed and predicted values for the development of PVT.Conclusion A reduction in TG,an increase in D-dimer,prolonged PT,and a history of splenectomy are independent risk factors for PVT in cirrhotic patients with esophageal varices,and the nomogram developed based on these results can provide a quantitative and intuitive tool for clinicians to assess the risk of PVT.