内脏静脉血栓形成患者的生存和复发情况。

Survival and recurrence in patients with splanchnic vein thromboses.

机构信息

Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.

出版信息

Clin Gastroenterol Hepatol. 2010 Feb;8(2):200-5. doi: 10.1016/j.cgh.2009.09.019. Epub 2009 Sep 25.

DOI:10.1016/j.cgh.2009.09.019

PMID:19782767

Abstract

BACKGROUND & AIMS: Hepatic, splenic, portal, and mesenteric veins are confluent elements within the splanchnic system. It is therefore unclear whether thromboses of isolated segments represent unique entities. We compared etiologies, recurrence, and survival of patients with thromboses of different splanchnic venous segments.

METHODS

An inception cohort of individuals was identified with first lifetime incident of splanchnic vein thrombosis between 1980 and 2000. We performed a case-controlled comparison of recurrent thrombosis and survival data with those of patients with deep venous thrombosis (DVT).

RESULTS

The study (832 patients; mean age, 53 +/- 17 years; 42% women) included patients with isolated portal (n = 329), mesenteric (n = 76), splenic (n = 62), and hepatic (n = 45) vein thrombosis and patients with multisegment involvement (n = 320). Malignancy (27%) and cirrhosis (24%) were the most common etiologies. Recurrence-free survival 10 years after splanchnic vein thrombosis (76%) was comparable with that after DVT (68%) and not improved by anticoagulant therapy. Hormone therapy was the only independent predictor of recurrence (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.09-4.45; P = .03). Major bleeding was 6.9/100 patient-years. Gastroesophageal varices (HR, 2.63; 95% CI, 1.72-4.03; P < .001) and warfarin therapy (HR, 1.91, 95% CI, 1.25-2.92; P = .003) were independent predictors of bleeding. The 10-year survival rate of patients with splanchnic vein thrombosis (60%) was lower than that of patients with DVT (68%, P < .05). Older age (HR, 1.03; 95% CI, 1.02-1.03), active cancer (HR, 2.23; 95% CI, 1.78-2.78), and myeloproliferative disorder (HR, 1.92; 95% CI, 1.41-2.61) were independent determinants of mortality (P < .001).

CONCLUSIONS

Splanchnic vein thrombosis depends on the pathology of the organ supplied. On the basis of the low rate of recurrence and substantial rate of major hemorrhage, prolonged anticoagulant therapy does not appear to be justified.

摘要

背景与目的

肝、脾、门静脉和肠系膜静脉是内脏系统中融合的元素。因此，孤立段血栓形成是否代表独特的实体尚不清楚。我们比较了不同内脏静脉段血栓形成患者的病因、复发和生存率。

方法

在 1980 年至 2000 年间，我们确定了首例内脏静脉血栓形成的个体为起始队列。我们对复发性血栓形成和生存数据进行了病例对照比较，并与深静脉血栓形成（DVT）患者的数据进行了比较。

结果

该研究（832 例患者；平均年龄 53±17 岁；42%为女性）包括孤立性门静脉（n=329）、肠系膜（n=76）、脾（n=62）和肝（n=45）静脉血栓形成患者，以及多节段受累患者（n=320）。恶性肿瘤（27%）和肝硬化（24%）是最常见的病因。内脏静脉血栓形成 10 年无复发生存率（76%）与 DVT（68%）相当，抗凝治疗并未改善。激素治疗是唯一的独立复发预测因素（危险比[HR]，2.2；95%置信区间[CI]，1.09-4.45；P=0.03）。主要出血为 6.9/100 患者年。胃食管静脉曲张（HR，2.63；95%CI，1.72-4.03；P<.001）和华法林治疗（HR，1.91，95%CI，1.25-2.92；P=0.003）是出血的独立预测因素。内脏静脉血栓形成患者的 10 年生存率（60%）低于 DVT 患者（68%，P<.05）。年龄较大（HR，1.03；95%CI，1.02-1.03）、活动性癌症（HR，2.23；95%CI，1.78-2.78）和骨髓增生性疾病（HR，1.92；95%CI，1.41-2.61）是死亡的独立决定因素（P<.001）。