Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie-Pancréatologie, Hôpital Beaujon, AP-HP, Clichy, Inserm U773-CRB3, Université Paris-Diderot, Clichy, France.
Am J Gastroenterol. 2012 Oct;107(10):1579-85. doi: 10.1038/ajg.2012.231. Epub 2012 Jul 24.
Extrahepatic portal venous system thrombosis (EPVST) occurs in 13% of patients with either recurrent acute (AP) or chronic (CP) alcoholic pancreatitis. The role of thrombophilia has never been assessed in this entity.
All consecutive patients with alcoholic AP or CP were included in a prospective study. All patients underwent a computerized tomography (CT) scan of the pancreas to evaluate EPVST as well as thorough testing for thrombophilia (protein C, S, and antithrombin deficiency, factor II, factor V, and JAK2 gene mutations, homocystein, biological antiphospholipid syndrome).
A total of 119 patients (male, n=100 (84%); smokers, n=110 (92%)) were included. EPVST was found in 41 patients (35%). The portal, superior mesenteric, or splenic veins were involved in 34%, 24%, and 93% of patients, respectively. Thrombophilia was identified in 18% (n=22), including the biological antiphospholipid syndrome, factor V Leiden mutation, and factor II G20210A gene mutation in 21 (17.6%), 2 (1.6%), and 1 patient (0.8%), respectively. On univariate analysis, the factors associated with EPVST were smoking (RR=1.6 (1.38-1.85), P=0.03), pseudocysts (RR=2.91 (1.29-6.56), P=0.008), a pseudocyst in the pancreatic tail (P=0.03), a high CT severity index for AP (P=0.007), and pancreatic parenchymal necrosis (P=0.02). The presence of hemostatic risk factors was not associated with an increased risk of EPVST. On multivariate analysis, only pseudocysts were associated with EPVST (hazard ratio: 6.402; 95% confidence interval (1.59-26.54), P=0.009).
EPVST is found in 35% of patients with acute/chronic alcoholic pancreatitis. Local inflammation appears to be the major predisposing condition. The presence of some form of thrombophilia does not increase the risk of EPVST and should not be systematically searched for in case of EPVST.
在复发性急性（AP）或慢性（CP）酒精性胰腺炎患者中，13%会发生肝外门静脉系统血栓形成（EPVST）。血栓形成倾向在这种情况下从未被评估过。
所有连续的酒精性 AP 或 CP 患者均纳入前瞻性研究。所有患者均行胰腺计算机断层扫描（CT）以评估 EPVST，并进行全面的血栓形成倾向检查（蛋白 C、S 和抗凝血酶缺乏、因子 II、因子 V 和 JAK2 基因突变、同型半胱氨酸、生物性抗磷脂综合征）。
共纳入 119 例患者（男性 100 例[84%]；吸烟者 110 例[92%]）。41 例患者（35%）发现 EPVST。门静脉、肠系膜上静脉或脾静脉受累分别占 34%、24%和 93%的患者。18%（n=22）的患者发现存在血栓形成倾向，包括生物性抗磷脂综合征、因子 V Leiden 突变和因子 II G20210A 基因突变，分别占 17.6%、1.6%和 0.8%的患者。单因素分析显示，与 EPVST 相关的因素包括吸烟（RR=1.6（1.38-1.85），P=0.03）、假性囊肿（RR=2.91（1.29-6.56），P=0.008）、胰尾假性囊肿（P=0.03）、急性胰腺炎 CT 严重指数高（P=0.007）和胰腺实质坏死（P=0.02）。存在止血危险因素与 EPVST 风险增加无关。多因素分析显示，仅假性囊肿与 EPVST 相关（风险比：6.402；95%置信区间（1.59-26.54），P=0.009）。
急性/慢性酒精性胰腺炎患者中，35%存在 EPVST。局部炎症似乎是主要的易患条件。存在某种形式的血栓形成倾向并不会增加 EPVST 的风险，因此在 EPVST 的情况下不应系统地寻找。
