Girleanu Irina, Stanciu Carol, Cojocariu Camelia, Boiculese Lucian, Singeap Ana-Maria, Trifan Anca
Institute of Gastroenterology and Hepatology, "St Spiridon" Emergency Hospital, Iasi, Romania.
Saudi J Gastroenterol. 2014 Sep-Oct;20(5):288-92. doi: 10.4103/1319-3767.141687.
BACKGROUND/AIM: Portal vein thrombosis (PVT) has a high incidence in patients with liver cirrhosis and determines a poor prognosis of hepatic disease. The aim of our study was to define the natural course of partial PVT in cirrhotic patients, including survival and decompensation rates.
We performed a prospective, cohort study, in a tertiary referral center. There were 22 cirrhotic patients with partial nonmalignant PVT, without anticoagulant treatment, who were followed-up between January 2011 and October 2013. All patients were evaluated by Doppler abdominal ultrasound and computed tomography. Kaplan-Meier method was used to determine the difference in clinical events between the study subgroups.
After a mean follow-up period of 20.22 months, partial PVT improved in 5 (22.73%), was stable in 11 (50%), and worsened in 6 (27.27%) patients. Hepatic decompensation rate at 6 and 18 months was higher in patients with worsened PVT than in those with stable/improved PVT (50% vs. 25%, P < 0.0001 and 100% vs. 56.25%, P < 0.0001, respectively). The survival rate at 6 months was 66.66% in worsened PVT group vs. 81.25% (P = 0.005) in stable/improved group, and 16.66% vs. 81.25% (P < 0.0001) at 18 months, respectively. Multivariate analysis showed that Model of End-Life Disease was the independent predictor of hepatic decompensation [hazard ratio (HR) 1.42; 95% confidence interval (CI): 1.08-1.87, P = 0.012] and survival (HR 1.76; 95% CI: 1.06-2.92, P = 0.028).
Nonmalignant partial PVT remained stable/improved in over half of cirrhotic patients and aggravated in more than one fourth in whom it negatively influenced the survival and decompensation rates.
背景/目的：门静脉血栓形成（PVT）在肝硬化患者中发病率较高，且预示着肝脏疾病预后不良。本研究旨在明确肝硬化患者部分门静脉血栓形成的自然病程，包括生存率和失代偿率。
我们在一家三级转诊中心进行了一项前瞻性队列研究。纳入22例患有部分非恶性门静脉血栓形成且未接受抗凝治疗的肝硬化患者，于2011年1月至2013年10月进行随访。所有患者均接受腹部多普勒超声和计算机断层扫描评估。采用Kaplan-Meier法确定研究亚组之间临床事件的差异。
平均随访20.22个月后，5例（22.73%）患者的部分门静脉血栓形成情况改善，11例（50%）稳定，6例（27.27%）恶化。门静脉血栓形成恶化患者6个月和18个月时的肝脏失代偿率高于血栓形成稳定/改善的患者（分别为50%对25%，P<0.0001；100%对56.25%，P<0.0001）。门静脉血栓形成恶化组6个月时的生存率为66.66%，而稳定/改善组为81.25%（P=0.005），18个月时分别为16.66%和81.25%（P<0.0001）。多因素分析显示，终末期肝病模型是肝脏失代偿[风险比（HR）1.42；95%置信区间（CI）：1.08 - 1.87，P = 0.012]和生存（HR 1.76；95% CI：1.06 - 2.92，P = 0.028）的独立预测因素。
超过半数的肝硬化患者非恶性部分门静脉血栓形成保持稳定/改善，超过四分之一的患者病情加重，且对生存率和失代偿率产生负面影响。
