促抗凝失平衡与肝硬化门静脉高压症脾切断流术后门静脉血栓形成的关系

Contribution of coagulation imbalance in development of portal vein thrombosis after splenectomy and esophagogastric devascularization for cirrhotic portal hypertension

目的分析促抗凝失平衡与肝硬化门静脉高压症(PHT)行脾切除及贲门周围血管离断术后门静脉血栓(PVT)形成的相关性。方法回顾性分析2018年1月至2020年12月南京市第二医院因肝硬化PHT行脾切断流术的76例患者的临床资料,根据术后第7天超声检查门静脉是否发生血栓,分为血栓组(n=23)和非血栓组(n=53),对可能导致PVT形成的相关因素进行Logistic单因素和多因素分析。结果术后第7天血栓组与非血栓组凝血相关指标中蛋白S、内皮细胞蛋白C受体、血栓调节蛋白、血管假血友病因子差异无统计学意义,两组蛋白C(PC)[(4.96±1.94)µg/mL vs(6.17±1.55)µg/mL,t=-2.895,P=0.005]、凝血因子Ⅷ(FⅧ)[(127.45±12.09)ng/mL vs(120.69±9.74)ng/mL,t=2.581,P=0.012]及FⅧ/PC[(29.80±12.08)vs(20.86±5.75),t=4.387,P<0.001]差异均有统计学意义。多因素分析显示,术后第7天FⅧ/PC是PVT形成的独立危险因素(HR 1.296,95%CI 1.002~1.676,P=0.048)。结论对于肝硬化门静脉高压症的患者,FⅧ/PC是行脾切除及贲门周围血管离断术后PVT形成的独立危险因素。

Objective To investigate the relationship between portal vein thrombosis(PVT)and coagulation imbalance after splenectomy and esophagogastric devascularization in patients with cirrhotic portal hypertension.Methods Clinical data of 76 patients underwent splenectomy and esophagogastric devascularization for portal hypertension between Jan.2018 and Dec.2020 were retrospectivly analyzed.According to the ultrasound findings at day 7 postoperative,patients were divided into PVT group(n=23)and non-PVT group(n=53).The risk factors of PVT were analyzed with univariate and multivariate analysis.Results The differences of coagulation indicators(protein S,endothelial cell protein C receptor,thrombomodulin,vascular pseudohemophilia factor)at day 7 postoperative were not significant between the two groups.However,there were statistical significant differences in postoperative PC[(4.96±1.94)µg/mL vs(6.17±1.55)µg/mL,t=-2.895,P=0.005],FⅧ[(127.45±12.09)ng/mL vs(120.69±9.74)ng/mL,t=2.581,P=0.012]and FⅧ/PC[(29.80±12.08)vs(20.86±5.75),t=4.387,P<0.001]between PVT group and non-PVT group.In multivariate analysis,FⅧ/PC at day 7 postoperative was an independent risk factor for PVT(HR 1.296,95%CI 1.002~1.676,P=0.048).Conclusion Coagulation imbalance FⅧ/PC is an independent risk factor for portal vein thrombosis in patients after splenectomy and esophagogastric devascularization for portal hypertension.