Med Princ Pract. 2018;27(5):466-471. doi: 10.1159/000492893. Epub 2018 Aug 14.
Nonselective β-blockers (NSBB) are used in liver cirrhosis (LC) to prevent variceal bleeding because they decrease portal pressure. A main risk factor for the development of portal vein thrombosis (PVT) in LC is decreased portal vein inflow velocity. The aim of our study was to examine retrospectively the incidence of PVT and its correlation with the use of β-blockers in a cohort of LC patients.
Data from 230 LC patients (90% Child-Pugh class A), who had been followed up for at least 5 years, were reviewed. The diagnosis of PVT was made by ultrasound. The presence of PVT was evaluated with multiple logistic regression analysis where the independent variables were those significant in the univariate analysis.
The prevalence of PVT at baseline was 4.5%, and the incidence was 4.3% at 5 years; among the subjects taking β blockers, 46.4% were taking NSBB. A total of 19 PVT cases were found. Grade of esophageal varices (p < 0.01), PLT (p < 0.003), INR (p < 0.03), spleen diameter (p < 0.001) and PLT/spleen ratio (p < 0.0005) were significantly associated with PVT. The use of NSBB indicated a higher risk of PVT compared to selective β-blockers (SBB) (p < 0.05). In logistic regression analysis only the grade of esophageal varices was significant (p < 0.02). Univariate analysis of patients taking β-blockers showed an association of PVT with grade of esophageal varices (p < 0.01), CP class (p < 0.02), AST (p < 0.03), ALT and albumin (p < 0.02), PLT count and PLT/LD (p < 0.03), longitudinal diameter of the spleen (p < 0.005), ascites (p < 0.05), portal vein (p < 0.0001) and NSBB (OR 8.1; 95% CI 1.7-38.8).
NSBB seem to play a role in PV thrombogenesis. Further studies are needed, especially in decompensated LC patients.
非选择性β受体阻滞剂（NSBB）用于肝硬化（LC）以预防静脉曲张出血，因为它们可以降低门静脉压力。LC 中门静脉血栓形成（PVT）的一个主要危险因素是门静脉流入速度降低。我们研究的目的是回顾性检查一组 LC 患者的 PVT 发生率及其与β受体阻滞剂使用的相关性。
回顾性分析了 230 例至少随访 5 年的 LC 患者的数据。通过超声诊断 PVT。使用多元逻辑回归分析评估 PVT 的存在，其中独立变量为单因素分析中显著的变量。
基线时 PVT 的患病率为 4.5%，5 年内的发病率为 4.3%；在服用β受体阻滞剂的患者中，46.4%服用 NSBB。共发现 19 例 PVT 病例。食管静脉曲张程度（p<0.01）、血小板（p<0.003）、INR（p<0.03）、脾脏直径（p<0.001）和血小板/脾脏比值（p<0.0005）与 PVT 显著相关。与选择性β受体阻滞剂（SBB）相比，NSBB 的使用表明 PVT 的风险更高（p<0.05）。在逻辑回归分析中，只有食管静脉曲张程度具有显著意义（p<0.02）。对服用β受体阻滞剂的患者进行单因素分析显示，PVT 与食管静脉曲张程度（p<0.01）、CP 分级（p<0.02）、AST（p<0.03）、ALT 和白蛋白（p<0.02）、血小板计数和血小板/低密度脂蛋白（p<0.03）、脾脏长径（p<0.005）、腹水（p<0.05）、门静脉（p<0.0001）和 NSBB（OR 8.1；95%CI 1.7-38.8）相关。
NSBB 似乎在 PV 血栓形成中起作用。需要进一步的研究，特别是在失代偿性 LC 患者中。
