肝硬化门静脉系统血栓形成的危险因素分析

Analysis of the Etiology of Portal Vein Thrombosis in Liver Cirrhosis Patients

目的 探讨肝硬化门静脉系统血栓 (PVT)形成的危险因素。方法 检索我院自 1995～ 2 0 0 3年肝硬化PVT病例 ,除外术后血栓形成者 ,41例肝硬化合并PVT者入选血栓组。另随机选择同阶段肝硬化门脉高压症的非血栓病例 5 9例作为对照组。PVT的诊断依据彩色多普勒超声和 /或CT诊断。门静脉主干 (MPV)宽度由彩色超声测得 ,门静脉压力 (PVP)采用核素心肝血流比得到。采用spss软件对结果进行统计学分析。结果 logistic回归统计结果 (Chi-Square =3 5 5 1,P =0 0 0 0 )显示脾脏厚度、MPV、性别、及PVP是肝硬化合并PVT的危险因素 ( P =0 0 0 3、0 0 10、0 0 2 2和 0 0 2 6)。上诉危险因素重要性依次为脾脏厚度 >MPV >性别 >PVP(Wald值依次为 9 0 5、6 66、5 2 1和 4 96)。其中 ,女性相对男性优势比 (OR)为 3 3 4;脾脏厚度、MPV及PVP每增加一个单位其形成血栓的OR值分别为 2 15 ,2 0 8,1 0 4。统计学分析未提示肝功能Child -pugh分级、血小板计数、凝血酶原时间、血纤维蛋白原含量及饮酒比例等是肝硬化PVT形成的危险因素 (P >0 0 5 )。结论 女性患者 ,脾脏增大、MPV和PVP的增加是肝硬化PVT形成的危险因素。而肝功能分级。

Objective To study the etiology of portal vein thrombosis(PVT) formation in liver cirrhosis patients. Methods 41 cases of liver cirrhosis with PVT were enrolled in this study, which excluded the case with operation-induced PVT. 59 liver cirrhosis patients without PVT were chosen randomly as control group. The PVT was diagnosed by color Doppler ultrasound and/ or CT. The average width of main portal vein(MPV) were measured by color ultrasound. Portal vein pressure (PVP) was measured by radionuclide image. SPSS software was used for statistic analysis. Results Logistic regression model(Chi-Square=35 51,P=0 000)shows that the depth of spleen, the width of MPV, sex and PVP were the risk factors inducing PVT (P=0 003, 0 010, 0 022 and 0 026). The order of the importance of each factor was the depth of spleen>the width of MPV>sex>PVP, and Wald value was 9 05, 6 66, 5 21 and 4 96, respectively. The odds ratio(OR) of femal/male was 3 34, and the OR value of one unit increase of the depth of spleen, the width of MPV and PVP were 2 15, 20 8 and 1 04, respectively. However, no significant statistic differences were found in the etiology of cirrhosis, Child-pugh classification of liver function, blood platelet counting (BPC), prothrombin time (PT), and plasma fibrinogen level between the study and control groups(P>0 05). Conclusion Femal, splenomegaly and increase of the MPV width and PVP were the risk factors inducing PVT in liver cirrhosis patients, while liver function, BPC, PT, ect, may not be related to the formation of PVT.