引用本文:杨姣姣,卢高峰,吴嘉勋,朱壹澎,李 敏,任笑盈.肝硬化合并门静脉血栓的临床表现及危险因素分析[J].中国临床新医学,2019,12(11):1180-1184.
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肝硬化合并门静脉血栓的临床表现及危险因素分析
杨姣姣,卢高峰,吴嘉勋,朱壹澎,李 敏,任笑盈
450014 河南,郑州大学第二附属医院消化内科
摘要:
[摘要] 目的 分析肝硬化合并门静脉血栓(PVT)患者的临床表现及相关危险因素。方法 选取2012-10~2018-10在郑州大学第二附属医院诊治的肝硬化合并PVT患者59例(PVT组),随机选取同期住院的肝硬化未合并PVT患者78例作为对照(非PVT组)。收集患者的一般临床资料、实验室检查、影像学检查、临床表现及并发症情况等。比较两组患者的临床特点并分析PVT发生的影响因素。结果 两组血小板计数、平均血小板体积、血小板体积分布宽度、D-二聚体、纤维蛋白原、门静脉主干内径、脾脏厚度、脾脏长度、脾静脉内径、食管套扎术史、胃底硬化剂注射史、脾切除史差异有统计学意义(P<0.05)。二分类Logistic回归分析结果显示血小板计数升高(OR=1.014,P=0.008)、脾静脉内径增宽(OR=1.959,P=0.000)、脾脏厚度增加(OR=1.117,P=0.012)、有脾切除史(OR=4.559,P=0.001)是肝硬化患者发生PVT的独立危险因素。ROC曲线分析显示,脾脏厚度、血小板计数、脾静脉内径在诊断肝硬化合并PVT的曲线下面积(AUC)分别为0.595、0.640、0.725,脾静脉内径指标对肝硬化合并PVT的诊断价值最高。腹胀、消化道出血、发热、腹水、肝性脑病的发生率在两组间比较差异无统计学意义(P>0.05),而腹痛的发生率差异有统计学意义(P<0.05)。结论 脾静脉内径增宽、血小板计数升高、脾脏增厚、脾切除史是肝硬化合并PVT的独立危险因素,PVT形成可加重肝硬化患者的临床症状,造成相关并发症的发生率增加。
关键词:  肝硬化  门静脉血栓  临床特征  危险因素
DOI:10.3969/j.issn.1674-3806.2019.11.08
分类号:R 575.2
基金项目:河南省基础与前沿技术研究计划项目(编号:162300410128)
Clinical manifestations and risk factors of liver cirrhosis complicated with portal vein thrombosis
YANG Jiao-jiao, LU Gao-feng, WU Jia-xun, et al.
Department of Gastroenterology, the Second Affiliated Hospital of Zhengzhou University, Henan 450014, China
Abstract:
[Abstract] Objective To analyze the clinical manifestations and risk factors of liver cirrhosis complicated with portal vein thrombosis(PVT). Methods Fifty-nine patients with liver cirrhosis complicated with PVT were selected as PVT group from the Second Affiliated Hospital of Zhengzhou University during October 2012 and October 2018, and 78 cases of liver cirrhosis without PVT in the same period were randomly selected as controls(non-PVT group). The general clinical data, laboratory examination, imaging examination, clinical manifestations and complications of the patients were collected. The clinical features were compared between the two groups and the influencing factors of PVT were analyzed. Results There were significant differences in platelet count, mean platelet volume, platelet distribution width, D-dimer, fibrinogen, inner diameter of the main portal vein, spleen thickness, spleen length, inner diameter of the spleen vein, the history of esophageal ligation and injection of gastric fundus sclerosing agent, and the history of splenectomy between the two groups(P<0.05). The results of binary Logistic regression analysis showed that increased platelet count(OR=1.014, P=0.008), widened inner diameter of the splenic vein (OR=1.959, P=0.000), increased thickness of spleen(OR=1.117, P=0.012), and history of splenectomy(OR=4.559, P=0.001) were the independent risk factors of PVT in the patients with liver cirrhosis. Receiver operating characteristic(ROC) curve analysis showed that the area under the curve(AUC) of the spleen thickness, the platelet count and inner diameter of splenic vein were 0.595, 0.640 and 0.725 respectively in the diagnosis of liver cirrhosis complicated with PVT, and the index of the inner diameter of the splenic vein had the highest diagnostic value. The incidence rates of abdominal distention, gastrointestinal hemorrhage, fever, ascites and hepatic encephalopathy had no significant differences(P>0.05), while the incidence of abdominal pain had significant difference between the two groups(P<0.05). Conclusion Enlargement of the index of the inner diameter of the splenic vein diameter, increase of platelet count, thickening of spleen and history of splenectomy are the independent risk factors of liver cirrhosis complicated with PVT in patients with cirrhosis. PVT can aggravate the clinical symptoms and increase the incidence of related complications in patients with liver cirrhosis.
Key words:  Liver cirrhosis  Portal vein thrombosis(PVT)  Clinical features  Risk factors