Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA.
Department of Medicine, University of Virginia, Charlottesville, VA, USA.
Liver Int. 2018 Jan;38(1):94-101. doi: 10.1111/liv.13500. Epub 2017 Sep 9.
BACKGROUND & AIMS: Portal vein thrombosis (PVT) in cirrhosis may lead to hepatic decompensation and increased mortality. We aimed to investigate if decreased portal vein (PV) velocity is associated with future PVT.
Data on adult patients with cirrhosis and PVT between January 1, 2005 and July 30, 2015 were obtained. Cases with PVT were matched by age, gender and Model for End-stage Liver Disease (MELD) score to corresponding controls without PVT. Cox proportional hazards models, receiver operator curves and Kaplan Meier curves were constructed.
One hundred subjects (50 matched pairs) with mean age 53.8±13.1 y and MELD score 14.9±5.5 were included in our analysis. Sixty-four percent were male and 76% were Child-Turcotte-Pugh Class A or B. Baseline characteristics (prior to development of PVT) were similar, except for baseline PV velocity (16.9 cm/s, 95% CI 13.9-20.0 PVT vs 25.0, 95% CI 21.8-28.8 no PVT, P<.001). 30 PVT subjects had PV velocity <15 cm/s compared to five without PVT (P<.001). On adjusted multivariable analysis, PV velocity was the strongest independent risk factor predicting PVT development (HR 0.86, 95% CI 0.80-0.93). The predictive value for PVT development was greatest for flow <15 cm/s (c-statistic 0.77). PV velocity <15 cm/s had a highly significant association with future PVT (HR 6.00, 95% CI 2.20-16.40, P=<.001).
Decreased PV velocity is associated with increased risk of future PVT. Patients with cirrhosis and decreased PV velocity are a high-risk subgroup that warrants further investigation with prospective study.
肝硬化门静脉血栓形成（PVT）可导致肝失代偿和死亡率增加。我们旨在研究门静脉（PV）速度降低是否与未来发生 PVT 相关。
我们获得了 2005 年 1 月 1 日至 2015 年 7 月 30 日期间患有肝硬化和 PVT 的成年患者的数据。通过年龄、性别和终末期肝病模型（MELD）评分将 PVT 患者与相应的无 PVT 对照组进行匹配。构建 Cox 比例风险模型、受试者工作特征曲线和 Kaplan-Meier 曲线。
我们的分析纳入了 100 名患者（50 对匹配），平均年龄为 53.8±13.1 岁，MELD 评分为 14.9±5.5。64%为男性，76%为 Child-Turcotte-Pugh 分级 A 或 B。除了基线 PV 速度（16.9cm/s，95%CI 13.9-20.0，PVT 与 25.0cm/s，95%CI 21.8-28.8，无 PVT，P<.001）外，基线特征（在发生 PVT 之前）相似。30 名 PVT 患者的 PV 速度<15cm/s，而无 PVT 的患者为 5 名（P<.001）。在调整后的多变量分析中，PV 速度是预测 PVT 发展的最强独立危险因素（HR 0.86，95%CI 0.80-0.93）。流速<15cm/s 的预测价值最高（C 统计量 0.77）。PV 速度<15cm/s 与未来 PVT 有显著关联（HR 6.00，95%CI 2.20-16.40，P<.001）。
PV 速度降低与未来 PVT 风险增加相关。PV 速度降低的肝硬化患者是一个高危亚组，需要进一步研究前瞻性研究。
