肝硬化并发门静脉血栓的危险因素分析

摘要

目的 分析肝硬化并发门静脉血栓(PVT)患者的临床特点及相关危险因素.方法 选择2014年12月至2016年12月在武汉大学人民医院接受门静脉计算机断层血管造影(CTA)检查,发现PVT的肝硬化患者97例(PVT组),选择同期无PVT的肝硬化患者171例作为对照(无PVT组).PVT组又分为完全性PVT组和部分性PVT组.收集并比较患者的临床资料,进行统计学分析.结果 PVT组与无PVT组在病因分布上存在差异,PVT组血吸虫病导致肝硬化患者占比更高[16.5％(16/97)比7.6％(13/171)],PVT组的D二聚体水平较无PVT组升高(平均2.34 g/L比0.93 g/L),门静脉内径增加(中位数17 mm比15 mm),肝硬化患病时间更长(中位数4年比1年),既往有内镜下治疗史及脾切除术史的患者占比更高[36.1％(35/97)比22.2％(37/171),32.0％(31/97)比12.3％(21/171)],腹水程度更重[中重度/轻度/无:27.8％(27)/42.3％(41)/29.9％(29)比19.9％(34)/20.5％(35)/59.6％(102)],差异均有统计学意义(P均＜0.05),完全性PVT组与部分性PVT组在性别分布、血小板(PLT)计数、肝硬化患病时间以及既往脾切除史方面的差异有统计学差异(P＜0.05).结论 D二聚体水平升高、门静脉内径增宽、肝硬化患病时间较长、既往有内镜下治疗史和脾切除术史、并发腹水的肝硬化患者的PVT发病率较高.男性、PLT计数较高、肝硬化患病时间较长及有脾切除史的患者,PVT更倾向于完全性PVT.%Objective An attempt was made in this paper to investigate the clinical features and risk factors in liver cirrhosis patients complicated with portal vein thrombosis (PVT).Methods A total of 97 patients with liver cirrhosis complicated with PVT who were diagnosed by computed tomography angiography (CTA) from December 2014 to December 2016 were enrolled as the PVT group,and 171 cirrhotic patients without PVT were enrolled as controls (non-PVT group).In the PVT group,the complete and partial PVTs were further divided into subgroups.The clinical data were collected and compared with those of the control group by using statistical method.Results There were significant differences in pathogenesis,D-dimer (2.34 g/L vs 0.93 g/L),diameter of the portal vein (17 rnm vs 15 mm),duration of liver cirrhosis (4 years vs 1 year),endoscopic treatment [36.1％(35/97) vs 22.2％ (37/171)],splenectomy [32.0％ (31/97) vs 12.3％ (21/171)],and ascites[moderate-severe/mildo:27.8％(27)/42.3％ (41)/29.9％ (29) vs 19.9％ (34)/20.5％ (35)/59.6％ (102)] in the PVT and non-PVT groups (P＜0.05).There were significant differences in sex,PLT,splenectomy,duration of liver cirrhosis in subgroups.Conclusions Cirrhotic patients with a high levels of D-dimer,a large diameter of the portal vein,a long liver cirrhosis duration,endoscopic treatment,splenectomy and ascites tend to have a high incidence rate of PVT.Men,and patients with a high levels of PLT,a long liver cirrhosis duration,and splenectomy of PVT,tend to be complete PVT.