巴德-吉亚利综合征合并下腔静脉血栓形成的溶栓治疗效果及影响因素分析

Effect of thrombolytic therapy and influencing factors of Budd-Chiari syndrome with inferior vena cava thrombosis

目的探讨巴德-吉亚利综合征(B-CS)合并下腔静脉血栓形成患者行溶栓治疗的效果及其影响因素。方法回顾性分析郑州大学第一附属医院2013年1月至2020年8月收治的67例B-CS合并下腔静脉血栓形成患者的资料。男性30例,女性37例,年龄(47.7±11.1)岁(范围:18~72岁)。所有患者均行下腔静脉置管溶栓治疗,溶栓后行下腔静脉成形术,记录患者血栓溶解情况、并发症及治疗结果。采用t检验、χ^(2)检验、Mann-Whitney U检验进行溶栓治疗效果的单因素分析,采用非条件Logistic回归模型进行多因素分析。结果67例患者中,47例最终溶栓成功,溶栓第1、2、3、4周的溶栓成功率分别为9.0%、29.9%、64.2%、70.1%。溶栓第1、2、3、4周的导管相关感染发生率分别为1.5%、4.5%、14.9%、31.3%。所有患者下腔静脉成形术围手术期未发生症状性及急性肺栓塞等严重并发症。溶栓成功组和溶栓失败组的血栓长度[(36.7±18.1)mm比(52.0±16.4)mm,t=-3.234,P=0.002]、Child-Pugh分级(A~C级分别为37、8、2例比10、8、2例,Z=-2.310,P=0.021)、预开通下腔静脉比例[68.1%(32/47)比35.0%(7/20),χ^(2)=6.313,P=0.012]差异有统计学意义。多因素分析结果显示,血栓长度(OR=0.948,95%CI:0.913~0.984,P=0.005)、预开通下腔静脉(OR=5.451,95%CI:1.469~20.228,P=0.011)是溶栓效果的独立影响因素。结论B-CS合并下腔静脉血栓形成患者溶栓治疗效果满意,溶栓时间应以3周内为宜。溶栓失败的患者行下腔静脉成形术安全、有效,预开通下腔静脉是提高溶栓效果的重要方法。

Objective To examine the effect of thrombolytic therapy of Budd-Chiari syndrome(B-CS)with inferior vena cava(IVC)thrombosis,and the prognosis factors of it.Methods The clinical data of 67 patients of B-CS with IVC thrombosis treated in the Department of Hepatopancreatobiliary Surgery,the First Affiliated Hospital of Zhengzhou University from January 2013 to August 2020 were analyzed retrospectively.There were 30 males and 37 females.The age was(47.7±11.1)years(range:18 to 72 years).All patients received catheter directed thrombolysis,and the thrombolysis process,complications and outcomes were analyzed.All patients received IVC balloon angioplasty after thrombolytic therapy.The t test,χ2 test,Mann-Whitney U test were used for univariate analysis of the prognosis factors of thrombolysis effects,while unconditional Logistic regression model were used for multivariate analysis.Results In the 67 patients,47 cases succerssed in thrombolytic therapy.The successful rates of thrombolysis at 1-,2-,3-and 4-week were 9.0%,29.9%,64.2%and 70.1%,respectively.The rates of thrombolytic catheter-related infection at 1-,2-,3-and 4-week were 1.5%,4.5%,14.9%and 31.3%,respectively.No serious complications such as symptomatic and acute pulmonary embolism occurred during perioperative period of IVC balloon angioplasty.Univariate analysis showed that differences in thrombus length((36.7±18.1)mm vs.(52.0±16.4)mm,t=-3.234,P=0.002),Child-Pugh classification(class A/B/C:37/8/2 vs.10/8/2,Z=-2.310,P=0.021)and pre-opening IVC proportion(68.1%(32/47)vs.35.0%(7/20),χ^(2)=6.313,P=0.012)were statistically significant.The thrombus length(OR=0.948,95%CI:0.913 to 0.984,P=0.005),pre-opening IVC(OR=5.451,95%CI:1.469 to 20.228,P=0.011)were independent prognosis factors of thrombolytic effect.Conclusions Thrombolytic therapy for B-CS with IVC thrombosis were satisfactory,and the thrombolysis duration should be confined within 3 weeks.IVC balloon angioplasty is safe and effective for patients failing in thrombolysis,and pre-opening IVC is an important method to improve the thrombolytic effect.