Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Gastroenterology, Minhang Hospital, Fudan University, Shanghai, China.
J Dig Dis. 2023 Apr;24(4):284-292. doi: 10.1111/1751-2980.13194. Epub 2023 Jun 27.
Portal venous thrombosis (PVT) in cirrhotic patients is usually asymptomatic and diagnosed incidentally. In this study we aimed to investigate the prevalence and characteristics of advanced PVT in cirrhotic patients with a recent episode of gastroesophageal variceal hemorrhage (GVH).
Cirrhotic patients with recent GVH at one month before their admission for further treatment to prevent rebleeding were retrospectively recruited. Hepatic venous pressure gradient (HVPG) measurements, contrast-enhanced computed tomography (CT) scan of the portal vein system, and endoscopy were performed. PVT was diagnosed by CT examination and classified as none, mild and advanced.
Of the 356 patients enrolled, 80 (22.5%) had advanced PVT. Elevated levels of white blood cells (WBC) and serum D-dimer were observed in advanced PVT patients compared with those with no or mild PVT. Moreover, HVPG was lower in patients with advanced PVT, with fewer patients having HVPG exceeding 12 mmHg, while grade III esophageal varices and varices with red signs were more prevalent. Multivariate analysis showed that WBC count (odds ratio [OR] 1.401, 95% confidence interval [CI] 1.171-1.676, P < 0.001), D-dimer level (OR 1.228, 95% CI 1.117-1.361, P < 0.001), HVPG (OR 0.942, 95% CI 0.900-0.987, P = 0.011), and grade III esophageal varices (OR 4.243, 95% CI 1.420-12.684, P = 0.010) were associated with advanced PVT.
Advanced PVT, which is associated with a more severe hypercoagulable and inflammatory status, causes severe prehepatic portal hypertension in cirrhotic patients with GVH.
肝硬化患者的门静脉血栓形成（PVT）通常无症状，且为偶然诊断。本研究旨在探讨近期发生食管胃静脉曲张出血（GVH）的肝硬化患者中晚期 PVT 的患病率和特征。
回顾性招募了在进一步治疗以防止再出血前一个月内因近期 GVH 入院的肝硬化患者。进行了肝静脉压力梯度（HVPG）测量、门静脉系统对比增强 CT 扫描和内镜检查。通过 CT 检查诊断 PVT，并将其分为无、轻度和晚期。
在纳入的 356 名患者中，80 名（22.5%）患有晚期 PVT。与无或轻度 PVT 患者相比，晚期 PVT 患者的白细胞（WBC）和血清 D-二聚体水平升高。此外，晚期 PVT 患者的 HVPG 较低，HVPG 超过 12mmHg 的患者较少，而 III 级食管静脉曲张和红色征静脉曲张更为常见。多变量分析显示，白细胞计数（比值比 [OR] 1.401，95%置信区间 [CI] 1.171-1.676，P<0.001）、D-二聚体水平（OR 1.228，95% CI 1.117-1.361，P<0.001）、HVPG（OR 0.942，95% CI 0.900-0.987，P=0.011）和 III 级食管静脉曲张（OR 4.243，95% CI 1.420-12.684，P=0.010）与晚期 PVT 相关。
晚期 PVT 与更严重的高凝和炎症状态相关，在患有 GVH 的肝硬化患者中导致严重的肝前门静脉高压。
