血浆D-二聚体、脾脏特征与肝硬化发生PVT的关系

Relationship between plasma D-dimer,spleen characteristics and PVT in cirrhosis

目的探讨血浆D-二聚体(D-D)、脾脏特征与肝硬化患者发生门静脉血栓(PVT)的关系。方法采用回顾性研究方法,选取本院187例肝硬化患者作为研究对象,其中44例伴有PVT(PVT组),另外143例不伴PVT(对照组)。查阅两组的病历资料,统计分析两组的血浆D-D、脾脏厚度、脾脏长度、门静脉内径、肝功能、血常规等临床资料,采用受试者工作曲线分析血浆D-D、脾脏厚度、脾脏长度在诊断肝硬化患者发生PVT中的价值。结果PVT组和对照组白细胞(WBC)、血小板(PLT)、丙氨酸氨基转移酶(ALT)、白蛋白(ALB)水平差异均无统计学意义(P>0.05);PVT组Hb低于对照组(P<0.05),PVT组门静脉内径及天门冬氨酸氨基转移酶(AST)高于对照组(P<0.05);PVT组血浆D-D、脾脏厚度、脾脏长度高于对照组(P<0.05);经绘制ROC曲线,血浆D-D诊断肝硬化PVT的灵敏度为91.47%、特异度为81.00%、曲线下面积(AUC)为0.868;脾脏厚度诊断肝硬化PVT的灵敏度为83.48%、特异度为68.92%、AUC为0.765;脾脏长度诊断肝硬化PVT的灵敏度为75.17%、特异度为66.04%、AUC为0.724。结论肝硬化发生PVT患者的血浆D-D及脾脏特征较单纯的肝硬化患者更加明显,检测血浆D-D及脾脏特征有利于临床诊断肝硬化患者发生PVT。

Aim To investigate the relationship between plasma D-dimer(D-D),spleen characteristics and portal vein thrombosis(PVT)in patients with liver cirrhosis.Methods Using retrospective research method,187 patients with liver cirrhosis treated in our hospital were selected as the research objects,of which 44 patients were accompanied by PVT(PVT group)and another 143 patients were not accompanied by PVT(control group);check the medical records of the two groups,make statistical analysis of plasma DD,spleen thickness,spleen length,portal vein diameter,liver function,blood routine and other basic data of the two groups,use the receiver operating curve to analyse the value of plasma DD,spleen thickness,and spleen length in diagnosing PVT in patients with liver cirrhosis.Results There was no significant difference in white blood cell(WBC),platelets(PLT),alanine aminotransferase(ALT)and albumin(ALB)between the PVT group and the control group(P>0.05).The Hb of the PVT group was lower than that of the control group(P<0.05).The portal vein diameter and aspartate aminotransferase(AST)of the PVT group were higher than those of the control group(P<0.05).The plasma D-D,spleen thickness,and spleen length of the PVT group were higher than those of the control group(P<0.05).After drawing the ROC curve,the sensitivity of plasma D-D to diagnose PVT in patients with liver cirrhosis is 91.47%,specificity is 81.00%,and the area under the curve(AUC)is 0.868.The sensitivity of spleen thickness to diagnose PVT in patients with liver cirrhosis is 83.48%,the specificity is 68.92%,and the AUC is 0.765;The sensitivity of spleen length to diagnose PVT in patients with liver cirrhosis is 75.17%,specificity is 66.04%,and AUC is 0.724.Conclusion Plasma D-D and spleen characteristics of patients with cirrhosis of PVT are more obvious than those of patients with simple cirrhosis.Detection of plasma D-D and spleen characteristics is helpful for clinical diagnosis of patients with PVT.