肝硬化并发门静脉血栓患者临床特征及其危险因素分析

doi:10.3969/j.issn.1672-5069.2020.03.025

摘要/Abstract

摘要： 目的总结肝硬化并发门静脉血栓(PVT)患者的临床特征并分析PVT形成的危险因素。方法回顾性分析2015年2月～2019年2月我院肝胆包虫科治疗的160例肝硬化患者,分析比较PVT组与未发生PVT组患者临床资料的差异,采用多因素分析发生PVT的危险因素。结果 80例PVT患者腹痛、腹水和消化道出血发生率、血小板(PLT)和白细胞(WBC)计数显著高于80例未发生PVT组(P<0.05);经多因素分析,发现PLT计数、糖尿病史和脾切除史为肝硬化并发门静脉血栓形成的独立危险因素(P<0.05)。结论肝硬化并发PVT患者以HGB、PLT、WBC为主要实验室表现,以腹水、下消化道出血、肝功异常为主要临床症状。PLT、糖尿病史和脾切除史为肝硬化并发门静脉血栓的独立危险因素。

关键词: 肝硬化, 门静脉血栓, 血小板, 糖尿病, 脾切除术, 危险因素 , ,

Abstract: Objective The aim of this study was to analyze the clinical characteristics and risk factors of portal vein thrombosis (PVT) in patients with liver cirrhosis (LC). Methods A retrospective analysis was made on 160 patients with LC admitted to our Department in our hospital from February 2015 through February 2019. The clinical symptoms, laboratory indexes and general data of patients were collected. The multivariate Logistic analysis was applied to evaluate the risk factors of PVT. Results The incidence of abdominal pain, ascites and gastrointestinal hemorrhage, and the platelet (PLT) counts and white blood cell (WBC) counts in 80 patients with PVT were significantly higher than those in 80 patients without PVT; the multivariate Logistic analysis showed that the PLT counts, diabetes and splenectomy were the independent risk factors for PVT in patients with LC (P<0.05). Conclusion The ascites, gastrointestinal hemorrhage and liver dysfunction are the main clinical manifestation in patients with LC and PVT, and the PLT counts, diabetes and splenectomy are the main independent risk factors for portal vein thrombosis.

Key words: Liver cirrhosis, Portal vein thrombosis, Platelets, Diabetes mellitus, Splenectomy, Risk factors

热那特·克力木,吐尔干艾力·阿吉,邵英梅. 肝硬化并发门静脉血栓患者临床特征及其危险因素分析[J]. 实用肝脏病杂志, 2020, 23(3): 401-404.

Rinat·Kirim, Turganaili·Aj, Shao Yinmei.. Clinical characteristics and risk factors of portal vein thrombosisin patients with liver cirrhosis[J]. Journal of Practical Hepatology, 2020, 23(3): 401-404.

参考文献

[1] Katsanos K, Al-Lamki SA, Parthipun A,et al. Peripheral stent thrombosis leading to acute limb ischemia and major amputation: Incidence and risk factors in the aortoiliac and femoropopliteal arteries. Cardiovasc Intervent Radiol, 2017, 40(3): 351-359.
[2] Chen J, Wu X, Keesee J, et al. Limited resuscitation with fresh or stored whole blood corrects cardiovascular and metabolic function in a rat model of polytrauma and hemorrhage. Shock, 2017, 47(2): 208-216.
[3] 章燕虹, 李游, 陈龙, 等. 2890例住院的肝硬化患者病因和并发症分析. 实用肝脏病杂志, 2018, 21(3): 344-347.
[4] Li G, Huang Y, Tang S, et al. A single-center retrospective study: Clinical features of different types of Budd-Chiari syndrome in Chinese patients in the Hubei area. Vascular, 2018, 26(1): 80-89.
[5] Thornburg B, Desai K, Hickey R, et al. Portal vein recanalization and transjugular intrahepatic portosystemic shunt creation for chronic portal vein thrombosis: Technical considerations. Tech Vasc Interv Radiol, 2016, 19(1): 52-60.
[6] Gastaca M, Prieto M, Palomares I, et al. Significance of measured intraoperative portal vein flows after thrombendvenectomy in deceased donor liver transplantations with portal vein thrombosis. Liver Transpl, 2018, 24(4): 565-566.
[7] Jiang TT, Luo XP, Sun JM, et al. Clinical outcomes of transcatheter selective superior mesenteric artery urokinase infusion therapy vs transjugular intrahepatic portosystemic shunt in patients with cirrhosis and acute portal vein thrombosis. World J Gastroenterol, 2017, 23(41): 7470-7477.
[8] Zuo C, Chumbalkar V, Ells PF, et al. Prevalence of histological features of idiopathic noncirrhotic portal hypertension in general population: a retrospective study of incidental liver biopsies. Hepatol Int, 2017, 11(5): 452-460.
[9] Loffredo L, Pastori D, Farcomeni A, et al. Effects of anticoagulants in patients with cirrhosis and portal vein thrombosis: A systematic review and meta-analysis. Gastroenterology, 2017, 153(2): 480-487.
[10] Sahin I, Reagan JL, Niroula R, et al. Refractoriness to red blood cell transfusion therapy due to hypersplenism. Transfusion, 2018, 58(11): 2513-2516.
[11] Wang P, Li Z, Ren S, et al. Spleen regulates hematopoietic stem/progenitor cell functions through regulation of EGF in cirrhotic hypersplenism. Dig Dis Sci, 2018, 63(7): 1860-1867.
[12] Chouhan MD, Mookerjee RP, Bainbridge A, et al. Caval subtraction 2D phase-contrast MRI to measure total liver and hepatic arterial blood flow: Proof-of-principle, correlation with portal hypertension severity and validation in patients with chronic liver disease. Invest Radiol, 2017, 52(3): 170-176.
[13] Guipaud O, Jaillet C, Clément-Colmou K, et al. The importance of the vascular endothelial barrier in the immune-inflammatory response induced by radiotherapy. Br J Radiol, 2018, 91(1089): 20170762.
[14] Do J, Gwak J, Rho JJ, et al. Aqueous extract of taegeuk ginseng inhibits platelet aggregation and thrombus formation. J Med Food, 2018, 21(11): 1137-1144.
[15] Vito CD, Hadi LA, Navone SE, et al. Platelet-derived sphingosine-1-phosphate and inflammation: From basic mechanisms to clinical implications. Platelets, 2016, 27(5): 393-401.
[16] van Santen DK, Schim van der Loeff MF, Cartier van Dissel J, et al. High proportions of liver fibrosis and cirrhosis in an ageing population of people who use drugs in Amsterdam, The Netherlands. Eur J Gastroenterol Hepatol, 2018, 30(10): 1168-1176.
[17] Williams MJ, Hayes P. Improving the management of gastrointestinal bleeding in patients with cirrhosis. Expert Rev Gastroenterol Hepatol, 2016, 10(4): 505-515.
[18] 王晓赵文霞.夜间加餐干预可促进失代偿期肝硬化患者肝功能恢复.实用肝脏病杂志, 2018, 21(1): 112-113.
[19] Pose E, Cardenas A. Translating our current understanding of ascites management into new therapies for patients with cirrhosis and fluid retention. Dig Dis, 2017, 35(4): 402-410.
[20] 郑俊福, 丁惠国.肝硬化急性食管胃静脉曲张出血临床救治新理念.实用肝脏病杂志, 2016, 19(5): 516-518.
[21] Khishfe BF, Sankovsky A, Nasr I. Idiopathic ovarian vein thrombosis: a rare cause of abdominal pain. Am J Emerg Med, 2016, 34(5): 935.
[22] Klinger C, Riecken B, Schmidt A, et al. Transjugular portal vein recanalization with creation of intrahepatic portosystemic shunt (PVR-TIPS) in patients with chronic non-cirrhotic, non-malignant portal vein thrombosis. Z Gastroenterol, 2018, 56(3): 221-237.
[23] Geng WZM, Fuller M, Osborne B, et al. The value of the erect abdominal radiograph for the diagnosis of mechanical bowel obstruction and paralytic ileus in adults presenting with acute abdominal pain. J Med Radiat Sci, 2018, 65(4): 259-266.
[24] Ruggeri P, Lo Bello F, Nucera F, et al. Hereditary hyperhomocysteinemia associated with nephrotic syndrome complicated by artery thrombosis and chronic thromboembolic pulmonary hypertension: A case report. Monaldi Arch Chest Dis, 2017, 87(3): 880.
[25] Yue-Meng W, Li YH, Wu HM, et al. Portal vein thrombosis in patients with cirrhosis undergoing elective transjugular intrahepatic portosystemic shunt: risk factors, warfarin efficacy, and clinical outcomes. Clin Appl Thromb Hemost, 2018, 24(3): 462-470.
[26] Yuan J, Xu GM. Early and late stent thrombosis in patients with versus without diabetes mellitus following percutaneous coronary intervention with drug-eluting stents: A systematic review and meta-analysis. Am J Cardiovasc Drugs, 2018, 18(6): 483-492.
[27] Wang H, Wang Z, Tang Q. Reduced expression of microRNA-199a-3p is associated with vascular endothelial cell injury induced by type 2 diabetes mellitus. Exp Ther Med, 2018, 16(4): 3639-3645.
[28] Lehmann M, Schoeman RM, Krohl PJ, et al. Platelets drive thrombus propagation in a hematocrit and glycoprotein vi-dependent manner in an in vitro venous thrombosis model. Arterioscler Thromb Vasc Biol, 2018, 38(5): 1052-1062.
[29] Sauter RJ, Sauter M, Obrich M, et al. Anaphylatoxin receptor C3aR contributes to platelet function, thrombus formation and In vivo haemostasis. Thromb Haemost, 2019, 119(1): 179-182.