Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China.
Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
Clin Gastroenterol Hepatol. 2020 Oct;18(11):2564-2572.e1. doi: 10.1016/j.cgh.2020.02.037. Epub 2020 Feb 25.
BACKGROUND & AIMS: Portal vein thrombosis (PVT) is a common and serious complication in patients with cirrhosis. However, little is known about PVT in patients with cirrhosis and acute decompensation (AD). We investigated the prevalence and clinical significance of PVT in nonmalignant patients with cirrhosis and AD.
We performed a retrospective study of 2 cohorts of patients with acute exacerbation of chronic liver disease who participated in the Chinese AcuTe on CHronic LIver FailurE study, established by the Chinese Chronic Liver Failure Consortium, from January 2015 through December 2016 (n = 2600 patients) and July 2018 through January 2019 (n = 1370 patients). We analyzed data on the prevalence, clinical manifestations, and risk factors of PVT from 2826 patients with cirrhosis, with and without AD.
The prevalence of PVT in patients with cirrhosis and AD was 9.36%, which was significantly higher than in patients with cirrhosis without AD (5.24%) (P = .04). Among patients with cirrhosis and AD, 63.37% developed PVT recently (the first detected PVT with no indication of chronic PVT). Compared with patients without PVT, a significantly higher proportion of patients with PVT had variceal bleeding (47.33% vs 19.63%; P < .001) and patients with PVT had a significantly higher median serum level of D-dimer (2.07 vs 1.25; P < .001). Splenectomy and endoscopic sclerotherapy were independent risk factors for PVT in patients with cirrhosis and AD. The 1-year mortality rate did not differ significantly between patients with vs without PVT.
In an analysis of data from 2826 patients with cirrhosis, a significantly higher proportion of those with AD had PVT than those without AD. PVT was associated with increased variceal bleeding, which would increase the risk for AD. Strategies are needed to prevent PVT in patients with cirrhosis, through regular screening, to reduce portal hypertension. ClinicalTrials.gov no: NCT02457637 and NCT03641872.
门静脉血栓形成（PVT）是肝硬化患者的一种常见且严重的并发症。然而，对于肝硬化合并急性失代偿（AD）患者的 PVT 知之甚少。我们研究了非恶性肝硬化合并 AD 患者中 PVT 的患病率和临床意义。
我们对参加由中国慢性肝脏衰竭联盟建立的中国急性加重慢性肝脏疾病研究的两个慢性肝病急性加重患者队列进行了回顾性研究，分别为 2015 年 1 月至 2016 年 12 月（n=2600 例）和 2018 年 7 月至 2019 年 1 月（n=1370 例）。我们分析了 2826 例肝硬化患者（伴或不伴 AD）的 PVT 患病率、临床表现和危险因素数据。
肝硬化合并 AD 患者的 PVT 患病率为 9.36%，明显高于无 AD 的肝硬化患者（5.24%）（P=0.04）。在肝硬化合并 AD 的患者中，63.37%的患者最近出现了 PVT（首次发现无慢性 PVT 迹象的 PVT）。与无 PVT 的患者相比，PVT 患者中食管胃静脉曲张出血的比例明显更高（47.33%比 19.63%；P<0.001），PVT 患者的 D-二聚体中位数水平也明显更高（2.07 比 1.25；P<0.001）。脾切除术和内镜下硬化治疗是肝硬化合并 AD 患者发生 PVT 的独立危险因素。有 PVT 与无 PVT 的患者 1 年死亡率无显著差异。
在对 2826 例肝硬化患者的数据进行分析后发现，AD 患者中 PVT 的比例明显高于无 AD 的患者。PVT 与食管胃静脉曲张出血增加有关，从而增加 AD 的风险。需要通过定期筛查来制定预防肝硬化患者 PVT 的策略，以降低门静脉高压。临床试验注册号：NCT02457637 和 NCT03641872。
