MAFLD相关肝硬化门静脉血栓形成的临床特征及危险因素分析

Analysis on clinical features and risk factors of liver cirrhosis portal vein thrombosis associated with metabolism-associated fatty liver disease*

目的分析代谢相关脂肪性肝病(MAFLD)相关肝硬化门静脉血栓(PVT)形成的临床特征及相关危险因素。方法回顾性分析该院收治的120例MAFLD相关肝硬化患者的临床资料,其中发生PVT患者33例为PVT组,未发生PVT患者87例为非PVT组。收集患者人口学资料、既往史、并发症、实验室指标、影像学指标等,计算Child-Pugh评分,多因素logistic回归分析MAFLD相关肝硬化PVT形成的独立危险因素。结果两组年龄,性别、吸烟史、饮酒史,合并高血压、糖尿病,并发腹水、肝性脑病、自发性腹膜炎,内镜下治疗史、Child-Pugh分级比例比较差异均无统计学意义(P>0.05);而合并冠心病、有脾切除史,并发食管胃底静脉曲张、消化道出血及脾功能亢进比例比较差异有统计学意义(P<0.05)。两组ALT、AST、碱性磷酸酶(ALP)、γ-谷氨酰胺转肽酶(GGT)、总胆红素(TBil)、胆汁酸(TBA)、白蛋白(ALB)、尿酸(UA)、甘油三酯(TG)、WBC、PLT、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、门静脉宽度分布比较差异有统计学意义(P<0.01),但总胆固醇(TC)、血红蛋白(Hb)、凝血酶时间(TT)、纤维蛋白原(Fib)比较差异无统计学意义(P>0.05)。高TG水平,并发脾功能亢进和食管胃底静脉曲张,有脾切除史是MAFLD相关肝硬化PVT形成的独立危险因素(OR=1.547、1.717、2.704、5.257,P=0.037、0.010、0.016、0.001)。结论MAFLD相关肝硬化患者应控制TG水平,尽量减少PVT形成;对于有食管胃底静脉曲张及脾功能亢进的MAFLD相关肝硬化患者应重点关注PVT,便于早期发现及干预,在进行脾切除术前评估时也应考虑后续PVT形成的风险。

Objective To analyze the clinical features and related risk factors of liver cirrhosis portal vein thrombosis(PVT)related with metabolic associated fatty liver disease(MAFLD).Methods The clinical data of 120 patients with MAFLD related cirrhosis admitted and treated in this hospital were analyzed retrospectively.Among them,33 patients developing PVT served as the PVT group and 87 patients without PVT occurrence as the control group.The demographic data,past history,complications,laboratory indexes and imageological indexes of the patients were collected.The Child-Pugh scores were calculated and the multivariate logistic regression was adopted to analyze the independent risk factors for MAFLD related liver cirrhosis PVT formation.Results There were no statistically significant differences in the age,sex,smoking history,complicating hypertension,complicating diabetes,complicating ascites,hepatic encephalopathy,spontaneous peritonitis and Child-Pugh grade had no statistical differences between the two groups(P>0.05),while complicating coronary heart disease,splenectomy history,complicating esophageal and gastric varices,digestive tract hemorrhage and the proportion of hypersplenism had statistical difference(P<0.05).ALT,AST,alkaline phosphatase(ALP),γ-glutamyl transpeptidase(GGT),total bilirubin(TBil),total bile acids(TBA),albumin(ALB),uric acid(UA),triglyceride(TG),WBC,PLT,prothrombin time(PT),activated partial thromboplastin time(APTT)and portal vein width distribution had statistical differences between the two groups(P<0.01),but serum total cholesterol(TC),hemoglobin(Hb),thrombin time(TT)and fibrinogen(Fib)had no statistical differences(P>0.05).The high TG level,complicating hypersplenism,complicating esophageal and gastric varices and splenectomy history were the independent risk factors for PVT formation in the patients with MAFLD-related liver cirrhosis(OR=1.547,1.717,2.704,5.257;P=0.037,0.010,0.016,0.001).Conclusion The patients with MAFLD-related cirrhosis should control the TG level to minimize the PVT formation,and for the patients with MAFLD-related liver cirrhosis complicating esophageal and gastric varices and hypersplenism,attention should be paid to PVT to facilitate early detection and intervention.The risk of subsequent PVT formation should also be considered in the preoperative evaluation of splenectomy.