II. Medical Department, Technical University Munich, Munich, Germany.
Hepatol Res. 2009 Sep;39(9):882-7. doi: 10.1111/j.1872-034X.2009.00531.x. Epub 2009 Jul 8.
Portal vein thrombosis (PVT) is a serious complication in patients with liver cirrhosis. In patients with advanced stages of liver cirrhosis plasmatic coagulation and platelet count are often reduced. However, patients with normal coagulation status might carry a high risk for developing PVT. A correlation between coagulation status used in clinical routine and the incidence of PVT in patients with liver cirrhosis has been evaluated in the present retrospective analysis.
88 patients with liver cirrhosis were identified by screening a database. Of these patients, 23 suffered from PVT. Patients were classified according to the Child-Pugh classification. Patients were subdivided into early stages (Child A) and advanced stages (Child B/C) of liver cirrhosis.
In patients with Child-Pugh A cirrhosis, there was no difference in activated partial thromboplastin time (apTT), international normalized ratio (INR), and platelet count between the PVT (n = 7) and the control group (n = 35). In contrast, the median apTT and INR were significantly lower in patients with Child B/C cirrhosis and PVT (n = 16) in comparison with patients without PVT (37 s vs 43 s [P = 0.017] and 1.25 vs 1.40 [P = 0.022]), respectively. Platelet count did not differ significantly in patients with advanced liver cirrhosis and PVT from those without PVT.
Patients with advanced liver cirrhosis and PVT displayed lower apTT and INR compared with those without PVT. Therefore, patients with advanced liver cirrhosis and almost normal coagulation parameters might be at particular risk of developing PVT. The results suggest that regular monitoring using Doppler-ultrasound should be carried out in these patients, especially when liver transplantation is intended.
门静脉血栓形成（PVT）是肝硬化患者的严重并发症。在肝硬化晚期患者中，血浆凝血和血小板计数通常会降低。然而，凝血状态正常的患者可能有发生 PVT 的高风险。本回顾性分析评估了临床常规凝血状态与肝硬化患者 PVT 发生率之间的相关性。
通过筛选数据库，确定了 88 例肝硬化患者。其中 23 例患有 PVT。根据 Child-Pugh 分类对患者进行分类。患者分为早期（Child A）和晚期（Child B/C）肝硬化。
在 Child-Pugh A 肝硬化患者中，PVT 组（n=7）与对照组（n=35）的活化部分凝血活酶时间（apTT）、国际标准化比值（INR）和血小板计数无差异。相比之下，Child B/C 肝硬化伴 PVT 患者（n=16）的平均 apTT 和 INR 明显低于无 PVT 患者（37 秒与 43 秒[P=0.017]和 1.25 与 1.40[P=0.022]）。晚期肝硬化伴 PVT 患者的血小板计数与无 PVT 患者无显著差异。
与无 PVT 的患者相比，晚期肝硬化伴 PVT 患者的 apTT 和 INR 较低。因此，晚期肝硬化且凝血参数几乎正常的患者可能有发生 PVT 的特殊风险。这些结果表明，应在这些患者中进行常规的多普勒超声监测，尤其是在计划进行肝移植时。
