基于倾向性评分匹配分析门静脉血栓对肝硬化患者预后的影响

Influence of portal vein thrombosis on the prognosis of patients with liver cirrhosis based on propensity score matching

目的分析门静脉血栓(PVT)对肝硬化患者短期预后的影响并探讨肝硬化患者预后的危险因素。方法回顾性分析西南医科大学附属医院2018年9月-2020年3月的肝硬化住院患者临床资料,其中合并PVT患者58例为PVT组,随机选取同期无PVT患者116例为非PVT组,通过1∶1倾向性评分匹配(PSM)均衡组间协变量获取PVT组及非PVT组各44例。满足正态性计量资料2组间比较采用t检验,非正态性计量资料2组间比较采用Mann-Whitney U秩和检验;计数资料2组间比较采用χ^(2)检验和Fisher确切概率法。利用Kaplan-Meier法及log-rank法分析PSM前后2组患者的生存情况及出血情况,并使用Cox风险模型分析PSM前后影响肝硬化患者预后的危险因素。结果PSM前非PVT组患者总体生存率明显高于PVT组(P=0.008),而PSM后2组患者总体生存率无明显差异(P=0.076)。PSM前非PVT组上消化道出血或再出血率明显低于PVT组(P<0.001),PSM后结果与PSM前一致(P=0.028)。PSM前肝硬化患者预后多因素分析显示,PVT(HR=2.944,95%CI:1.364~6.441,P=0.007)和MELD评分≥15(HR=3.531,95%CI:1.630~7.650,P=0.001)是肝硬化患者短期死亡的危险因素。PSM后肝硬化患者预后多因素分析显示,MELD评分≥15是肝硬化患者短期死亡的危险因素(HR=3.312,95%CI:1.049~10.457,P=0.041)。结论肝硬化合并PVT增加上消化道出血或再出血风险,但其不是肝硬化患者短期死亡的独立危险因素,MELD评分≥15是肝硬化患者短期死亡的独立危险因素。

Objective To investigate the influence of portal vein thrombosis(PVT)on the short-term prognosis of patients with liver cirrhosis and the risk factors for the prognosis of patients with liver cirrhosis.Methods A retrospective analysis was performed for the clinical data of the patients with liver cirrhosis who were hospitalized in our hospital from September 2018 to March 2020,among whom 58 patients with PVT were enrolled as PVT group and 116 patients without PVT were enrolled as non-PVT group,and 44 patients were selected from each group based on propensity score matching(PSM)at a ratio of 1∶1 to balance the covariates between groups.The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.The Kaplan-Meier method and the log-rank method were used to analyze survival status and bleeding before and after PSM,and the Cox risk model was used to analyze the risk factors for the prognosis of patients with liver cirrhosis.Results Before PSM,the non-PVT group had a significantly higher overall survival rate than the PVT group(P=0.008),while after PSM,there was no significant difference in overall survival rate between the two groups(P=0.076).Before PSM,the non-PVT group had significantly lower incidence rates of upper gastrointestinal bleeding or rebleeding than the PVT group before and after PSM(P<0.001),and the results after PSM were consistent with those before PSM(P=0.028).The multivariate analysis of the prognosis of the patients with liver cirrhosis before PSM showed that PVT(hazard ratio[HR]=2.944,95%confidence interval[CI]:1.364-6.441,P=0.007)and Model for End-Stage Liver Disease(MELD)score≥15(HR=3.531,95%CI:1.630-7.650,P=0.001)were risk factors for short-term death of the patients with liver cirrhosis,and the multivariate analysis after PSM showed that MELD score≥15(HR=3.312,95%CI:1.049-10.457,P=0.041)was a risk factor for short-term death of the patients with liver cirrhosis.Conclusion Liver cirrhosis with PVT increases the risk of upper gastrointestinal bleeding or rebleeding,but it is not an independent risk factor for short-term death in patients with liver cirrhosis.MELD score≥15 is an independent risk factor for short-term death in patients with liver cirrhosis.