Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China; Department of Gastroenterology, General Hospital of Jincheng Anthracite Coal Mining Group Co. Ltd, Jincheng, Shanxi Province, China.
Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
Thromb Res. 2018 Jan;161:7-11. doi: 10.1016/j.thromres.2017.11.010. Epub 2017 Nov 15.
The development of portal vein thrombosis (PVT) in cirrhotic patients has not been fully elucidated. The disseminated intravascular coagulation (DIC) score, which is based on readily available and relatively inexpensive coagulation parameters, including platelet count, fibrin-related markers, prothrombin time and fibrinogen, has not been reported regarding PVT development in cirrhotic patients to date. We aimed to evaluate the prognostic value of the DIC score in predicting PVT development in cirrhotic patients with hepatitis B.
A total of 109 cirrhotic patients with hepatitis B were included. Clinical data, laboratory tests and imaging were collected from the patients at baseline and every three months after enrollment. All patients were followed until the study endpoint (either occurrence of PVT or 12months after baseline). We measured routine laboratory parameters and conducted imaging examinations in cirrhotic patients and evaluated the prognostic value of the DIC score as a novel predictor for PVT in patients with cirrhosis. We also compared the effectiveness of the DIC score with other common coagulation and hemodynamic parameters.
Among the 109 patients, 14 (12.8%) developed PVT. At the study endpoint, significant increases in D-dimer, Child-Pugh score and DIC score (all P<0.001) and significantly reduced portal flow velocity (P<0.001) were noted in the PVT group. Among the selected factors, the DIC score had the largest area under the curve (AUC) (0.845), followed by the Child-Pugh score (0.778), D-dimer (0.732), and portal vein velocity (0.709).
Among the selected factors, the DIC score showed non-significantly higher diagnostic performance in predicting the PVT development in cirrhotic patients compared with other factors. A validation cohort of the study is needed in the near future.
肝硬化患者门静脉血栓形成（PVT）的发生机制尚未完全阐明。弥散性血管内凝血（DIC）评分基于血小板计数、纤维蛋白相关标志物、凝血酶原时间和纤维蛋白原等易于获得且相对便宜的凝血参数，目前尚未有研究报道其与肝硬化患者 PVT 发生的关系。本研究旨在评估 DIC 评分在预测乙型肝炎肝硬化患者 PVT 发生中的预后价值。
共纳入 109 例乙型肝炎肝硬化患者。收集患者基线及入组后每 3 个月的临床资料、实验室检查和影像学资料。所有患者均随访至研究终点（发生 PVT 或基线后 12 个月）。我们测量了肝硬化患者的常规实验室参数并进行了影像学检查，评估了 DIC 评分作为一种新的预测肝硬化患者 PVT 的指标的预后价值。我们还比较了 DIC 评分与其他常见凝血和血流动力学参数的有效性。
在 109 例患者中，14 例（12.8%）发生 PVT。在研究终点时，PVT 组 D-二聚体、Child-Pugh 评分和 DIC 评分显著升高（均 P<0.001），门静脉血流速度显著降低（P<0.001）。在所选因素中，DIC 评分的曲线下面积（AUC）最大（0.845），其次是 Child-Pugh 评分（0.778）、D-二聚体（0.732）和门静脉流速（0.709）。
在所选因素中，DIC 评分在预测肝硬化患者 PVT 发生方面的诊断性能略高于其他因素。在不久的将来需要对该研究进行验证队列研究。
