血栓弹力图对肝硬化患者门静脉血栓形成的预测价值

Evaluation value of thromboelastography for portal vein thrombosis in cirrhotic patients

目的探讨血栓弹力图(TEG)及常规凝血试验评价肝硬化患者门静脉血栓形成(PVT)的价值。方法选择2015年12月至2017年2月复旦大学附属中山医院消化科收治的肝硬化失代偿期患者,根据是否合并PVT分组。比较PVT组与非PVT组TEG参数、常规凝血指标、相关临床资料等的差异。结果共纳入199例患者,PVT组82例(41.2%)、无PVT组117例(58.8%)。两组患者TEG各项参数差异均无统计学意义。Logistic回归分析显示,女性(OR=3.061,95%CI 1.389~6.744,P=0.005)、脾切除史(OR=5.740,95%CI 1.876~17.568,P=0.002)、D-二聚体升高(OR=1.533,95%CI 1.182~1.989,P=0.001)是PVT的独立相关因素;Child B+C级(OR=12.844,95%CI 2.452~67.263,P=0.003)、R时间缩短(OR=0.526,95%CI0.294~0.942,P=0.031)、血小板增多(OR=1.013,95%CI 1.005~1.021,P=0.001)是门脉海绵样变的独立相关因素。结论TEG检测有助于预测PVT患者门脉海绵样变。

Objective To explore the value of thromboelastography(TEG)and conventional coagulation test in the diagnosis of portal vein thrombosis(PVT)in cirrhotic patients.Method Patients with decompensated cirrhosis admitted to the Department of Gastroenterology,Zhongshan Hospital,Fudan University,from December 2015 to February 2017 were enrolled.The patients were divided into two groups according to whether they had developed PVT.The clinical data,indexes of TEG and conventional coagulation were compared between the PVT group and non-PVT group.Results A total of 199 patients were included,with 82(41.2%)in the PVT group and 117(58.8%)in the non-PVT group.There were no statistically significant differences in TEG parameters between the two groups.Logistic regression analysis revealed that female(OR=3.061,95%CI 1.389-6.744,P=0.005),history of splenectomy(OR=5.740,95%CI 1.876-17.568,P=0.002),and elevated D-dimer(OR=1.533,95%CI 1.182-1.989,P=0.001)were independent associated factors of PVT;Child B/C(OR=12.844,95%CI 2.452-67.263,P=0.003),shortened R time(OR=0.526,95%CI 0.294-0.942,P=0.031),and increased platelet count(OR=1.013,95%CI 1.005-1.021,P=0.001)were independent associated factors of portal vein cavernous transformation.Conclusion TEG facilitates the evaluation of the development of portal vein cavernous transformation.