Lin G S, Xu Q, Zhao S Y, Zhang Y X
Infectious Disease Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China.
Infectious Disease Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China; State Key Laboratory Incubation Base of Xinjiang Major Diseases Research, Urumqi 830011, China.
Zhonghua Gan Zang Bing Za Zhi. 2016 Jul 20;24(7):513-517. doi: 10.3760/cma.j.issn.1007-3418.2016.07.006.
To investigate the clinical features of patients with liver cirrhosis complicated by portal vein thrombosis (PVT) and related risk factors. A total of 65 patients with liver cirrhosis complicated by PVT who were diagnosed and treated from June 2013 to June 2015 were enrolled as PVT group, and 70 cirrhotic patients without PVT were enrolled as controls (non-PVT group). The data collected included general information, results of laboratory examination, imaging findings, clinical manifestations, and complications. The clinical features were compared between the two groups, and related risk factors were screened out. There were no significant differences between the PVT group and non-PVT group in age, sex, nation, etiology, white blood cell count, platelet count, international normalized ratio, activated partial thromboplastin time, fibrinogen, serum creatinine, total bilirubin, and the diameter of the splenic vein (all > 0.05), while between these two groups, there were significant differences in D-dimer (1.87±1.45 mg/ml vs 0.55±0.58 mg/ml, < 0.05), fibrinogen degradation product (FDP) level (18.57±19.46 μg/ml vs 5.45±6.00 μg/ml, < 0.05), hemoglobin (99.32±26.73 g/L vs 112.64±25.03 g/L, < 0.05), albumin (28.51±5.19 g/L vs 33.07±7.94 g/L, < 0.05), the diameter of the portal vein (12.53±2.70 mm vs 11.17±1.79 mm, < 0.05), spleen thickness (5.12±0.95 cm vs 4.56±0.83 cm, < 0.05), spleen length (15.35±3.21 cm vs 13.86±2.82 cm, < 0.05), and Child-Pugh score (7.66±2.06 vs 6.93±1.87, < 0.05). The two groups showed no significant differences in diarrhea, ileus, hepatorenal syndrome, and hepatic encephalopathy ( > 0.05), but showed significant differences in abdominal pain (18 vs 7 cases, < 0.05), fever (17 vs 4 cases, < 0.05), esophageal variceal bleeding (22 vs 9 cases, < 0.05), and spontaneous peritonitis (24 vs 12 cases, < 0.05). D-dimer (OR = 4.290, < 0.000) and mean platelet volume (OR = 1.294, = 0.023) were independent risk factors for PVT in patients with liver cirrhosis. Cirrhotic patients with a high degree of liver cirrhosis, high levels of D-dimer and FDP, and a large diameter of the portal vein tend to have a high incidence rate of PVT. PVT can aggravate the clinical symptoms and significantly increase complications in patients with liver cirrhosis. An increased D-dimer level and a greater width of the main portal vein are independent risk factors for PVT in patients with liver cirrhosis.
探讨肝硬化合并门静脉血栓形成(PVT)患者的临床特征及相关危险因素。选取2013年6月至2015年6月期间诊断并治疗的65例肝硬化合并PVT患者作为PVT组,选取70例无PVT的肝硬化患者作为对照组(非PVT组)。收集的数据包括一般信息、实验室检查结果、影像学表现、临床表现及并发症。比较两组的临床特征,筛选出相关危险因素。PVT组与非PVT组在年龄、性别、民族、病因、白细胞计数、血小板计数、国际标准化比值、活化部分凝血活酶时间、纤维蛋白原、血清肌酐、总胆红素及脾静脉直径方面差异均无统计学意义(均P>0.05),而两组在D-二聚体(1.87±1.45mg/ml比0.55±0.58mg/ml,P<0.05)、纤维蛋白原降解产物(FDP)水平(18.57±19.46μg/ml比5.45±6.00μg/ml,P<0.05)、血红蛋白(99.32±26.73g/L比112.64±25.03g/L,P<0.05)、白蛋白(28.51±5.19g/L比33.07±7.94g/L,P<0.05)、门静脉直径(12.53±2.70mm比11.17±1.79mm,P<0.05)、脾厚度(5.12±0.95cm比4.56±0.83cm,P<0.05)、脾长度(15.35±3.21cm比13.86±2.82cm,P<0.05)及Child-Pugh评分(7.66±2.06比6.93±1.87,P<0.05)方面差异有统计学意义。两组在腹泻、肠梗阻、肝肾综合征及肝性脑病方面差异无统计学意义(P>0.05),但在腹痛(18例比7例,P<0.05)、发热(17例比4例,P<0.05)、食管静脉曲张破裂出血(22例比9例,P<0.05)及自发性腹膜炎(24例比12例,P<0.05)方面差异有统计学意义。D-二聚体(OR=4.290,P<0.000)及平均血小板体积(OR=1.294,P=0.023)是肝硬化患者发生PVT的独立危险因素。肝硬化程度高、D-二聚体和FDP水平高、门静脉直径大的患者PVT发生率往往较高。PVT可加重肝硬化患者的临床症状并显著增加并发症。D-二聚体水平升高及门静脉主干宽度增加是肝硬化患者发生PVT的独立危险因素。