利伐沙班抗凝治疗肝硬化门静脉血栓的疗效分析以及门静脉血栓再通的预测因素

Efficacy analysis of rivaroxaban anticoagulant in the treatment of cirrhotic portal vein thrombosis and predictors of portal vein thrombosis recanalization

目的探讨利伐沙班抗凝治疗肝硬化门静脉血栓(PVT)的疗效,并研究PVT再通的预测因素。方法回顾性分析2017年1月至2021年4月于滨州医学院附属医院消化内科接受治疗的肝硬化PVT患者93名,根据是否应用利伐沙班抗凝分为抗凝组和对照组,对比分析治疗3个月和6个月两组患者的PVT转归、血清学指标及出血情况等,利用单因素和多因素logistic回归分析影响PVT再通的相关因素,最后利用受试者工作特征曲线(ROC)分析PVT再通最终预测因素的预测价值。结果当利伐沙班抗凝治疗肝硬化PVT患者3个月和6个月时,抗凝组的总再通率均高于对照组,P均<0.05,而治疗6个月的总再通率高于3个月。当治疗6个月时,与对照组比较,抗凝组患者的总胆红素(TBIL)水平降低,凝血酶原时间(PT)延长,P均<0.05;两组在出血率方面差异无统计学意义。血栓形成时间联合诊断PVT至抗凝开始时间用于预测PVT再通时,其ROC曲线下面积(AUC)为0.808。结论利伐沙班抗凝治疗肝硬化合并PVT患者安全有效,抗凝治疗6个月的疗效可能优于3个月。利伐沙班抗凝治疗可以改善患者的肝功能,可以降低TBIL水平,延长PT。血栓形成时间、抗凝开始的时间可作为接受抗凝治疗肝硬化PVT患者门静脉再通的预测因素,且二者联合对于肝硬化PVT再通有一定预测价值。

Objective To explore the efficacy of rivaroxaban anticoagulation in the treatment of portal vein thrombosis(PVT)in cirrhosis,and study the predictors of PVT recanalization.Methods A retrospective analysis was performed on 93 patients with PVT with cirrhosis who received treatment in Department of Gastroenterology,Binzhou Medical UniversityHospital from January 2017 to April 2021.The patients were divided into the anticoagulation group and the control group according to whether rivaroxaban anticoagulation was applied.The PVT outcome,serological indicators and bleeding status of patients in the two groups after 3 and 6 months of treatment were compared and analyzed.The factors influencing PVT recanalization were analyzed by univariate and multivariate logistic regression,and the predictive value of the final predictors of PVT recanalization was analyzed by receiver operating characteristic curve(ROC).Results When rivaroxaban was used for anticoagulation at 3 and 6 months for patients with PVT with cirrhosis,the total recanalizationrate of the anticoagulation group was higher than that in control group,and the difference was statistically significant(P<0.05),while the total recanalization rate was higher at 6 months than that at 3 months.When the treatment time was 6 months,compared with those in the control group,the levels of total bilirubin(TBIL)in the anticoagulation group decreased,the prothrombin time(PT)in the anticoagulation group prolonged,and the differences were statistically significant(P<0.05).There was no significant difference in bleeding rate between the two groups(P>0.05).When the time of thrombus formation combined with the time of anticoagulant initiation was used to predict the recanalization of PVT,the area under the ROC curve(AUC)was 0.808.Conclusion Rivaroxaban is safe and effective in the treatment of patients with cirrhosis complicated with PVT.The efficacy of anticoagulation treatment for 6 months may be better than that for 3 months.Rivaroxaban anticoagulant therapy can improve the liver function of patients,reduce TBIL levels and prolong PT.The time of thrombus formation and time of anticoagulant initiation can be used as predictive factors for portal veinrecanalization in patients receiving anticoagulant therapy for PVT with cirrhosis,and their combination has certain predictive value forrecanalization ofPVT with cirrhosis.