Cazacu Sergiu Marian, Alexandru Dragoș Ovidiu, Dumitrescu Daniela, Vieru Alexandru Marian, Urhuț Marinela Cristiana, Săndulescu Larisa Daniela
Research Center of Gastroenterology and Hepatology, Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Petru Rares Street no. 2-4, 200349, Craiova, Romania.
Biostatistics Department, University of Medicine and Pharmacy of Craiova, Petru Rares Street no. 2-4, 200349 Craiova, Romania.
Diagnostics (Basel). 2024 Jul 6;14(13):1445. doi: 10.3390/diagnostics14131445.
Portal vein thrombosis (PVT) represents a restriction or occlusion of the portal vein by a blood clot, which can appear in liver cirrhosis, inherited or acquired thrombophilia, malignancies, abdominal infection, abdominal inflammation, and injury to the portal vein; it can evolve to local venous extension, recanalization, or portal cavernoma (PC). This research represents an observational study of patients admitted with a diagnosis of PVT between January 2018 and December 2022. We assessed the rate of and risk factors for PC. In total, 189 patients with PVT were included; the rate of PC was 14.8%. In univariate and multivariate analysis, the main risk factors for the presence of PC were etiology (thrombophilia, myeloproliferative disorders, local inflammatory diseases, and idiopathic causes), prior PVT, and complete versus incomplete or single-branch portal obstruction. In patients with superior mesenteric vein (SMV) thrombosis, distal obstruction was more prone to PC than proximal obstruction. The main predictive factors were etiology, prior PVT, complete PVT obstruction, and no prior non-selective beta-blocker (NSBB) use; in patients with SMV thrombosis, the distal extension was more significantly associated with the risk of PC. We propose a composite score for the prediction of PC which includes etiology, prior diagnosis of PVT, prior NSBB use, complete versus incomplete PVT, and distal versus proximal SMV thrombosis, with good accuracy (AUC 0.822) and an estimated sensitivity of 76.92% and specificity of 82.39% at a cut-off value of 4.
门静脉血栓形成（PVT）是指门静脉被血凝块阻塞或部分阻塞，可出现在肝硬化、遗传性或获得性血栓形成倾向、恶性肿瘤、腹部感染、腹部炎症以及门静脉损伤等情况中；它可发展为局部静脉扩展、再通或门静脉海绵样变性（PC）。本研究是一项对2018年1月至2022年12月期间诊断为PVT的住院患者的观察性研究。我们评估了PC的发生率及危险因素。总共纳入了189例PVT患者；PC的发生率为14.8%。在单因素和多因素分析中，PC存在的主要危险因素包括病因（血栓形成倾向、骨髓增殖性疾病、局部炎症性疾病和特发性病因）、既往PVT、完全性与不完全性或单分支门静脉阻塞。在肠系膜上静脉（SMV）血栓形成的患者中，远端阻塞比近端阻塞更容易发生PC。主要预测因素为病因、既往PVT、PVT完全阻塞以及未使用过非选择性β受体阻滞剂（NSBB）；在SMV血栓形成的患者中，远端扩展与PC风险的相关性更为显著。我们提出了一个用于预测PC的综合评分，其中包括病因、PVT的既往诊断、既往NSBB使用情况、PVT的完全性与不完全性以及SMV血栓形成的远端与近端情况，该评分具有良好的准确性（AUC 0.822），在临界值为4时，估计敏感性为76.92%，特异性为82.39%。
