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肝硬化食管静脉曲张患者门静脉血栓形成的危险因素分析

左怀文 沙启梅 孙姣 蔡智慧 许洪伟 刘慧

左怀文, 沙启梅, 孙姣, 等. 肝硬化食管静脉曲张患者门静脉血栓形成的危险因素分析[J]. 临床肝胆病杂志, 2021, 37(1): 63-67. DOI: 10.3969/j.issn.1001-5256.2021.01.013
引用本文: 左怀文, 沙启梅, 孙姣, 等. 肝硬化食管静脉曲张患者门静脉血栓形成的危险因素分析[J]. 临床肝胆病杂志, 2021, 37(1): 63-67. DOI: 10.3969/j.issn.1001-5256.2021.01.013
ZUO HW, SHA QM, SUN J, et al. Risk factors of portal vein thrombosis in cirrhotic patients with esophageal varices[J]. J Clin Hepatol, 2021, 37(1): 63-67. DOI: 10.3969/j.issn.1001-5256.2021.01.013
Citation: ZUO HW, SHA QM, SUN J, et al. Risk factors of portal vein thrombosis in cirrhotic patients with esophageal varices[J]. J Clin Hepatol, 2021, 37(1): 63-67. DOI: 10.3969/j.issn.1001-5256.2021.01.013

肝硬化食管静脉曲张患者门静脉血栓形成的危险因素分析

DOI: 10.3969/j.issn.1001-5256.2021.01.013
基金项目: 

山东省自然科学基金 ZR2014HM106

详细信息
    作者简介:

    左怀文(1994—),男,主要从事肝病及其他消化疾病的诊治研究

    通讯作者:

    刘慧,liuhuih3@126.com

  • 利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
  • 作者贡献声明:刘慧负责提出研究选题、终审论文;左怀文、沙启梅、孙姣负责设计研究方案、采集整理数据;左怀文负责调研整理文献、起草论文;蔡智慧负责统计分析;许洪伟提供指导性支持。
  • 中图分类号: R575.2

Risk factors of portal vein thrombosis in cirrhotic patients with esophageal varices

  • 摘要:   目的  旨在识别肝硬化食管静脉曲张患者中门静脉血栓(PVT)形成的独立危险因素,并建立一个预测PVT发生风险的列线图。  方法  回顾性分析2013年12月—2018年12月于山东大学附属省立医院就诊的283例肝硬化食管静脉曲张患者资料,根据影像学检查将其分为PVT组(n=119)和非PVT组(n=164)。计量资料两组间比较采用t检验或Mann-Whitney U检验,计数资料两组间比较采用χ2检验。利用多因素logistic回归分析筛选独立危险因素,基于多因素回归结果建立并检验列线图,应用C指数(C-index)、校准曲线评价其性能。  结果  单因素分析显示,PVT组在Child-Pugh分级(χ2=9.388,P=0.009)、脾切除史(χ2=26.805,P<0.001)、WBC(Z=-2.248,P=0.025)、PLT(Z=-3.323,P=0.001)、D-二聚体水平(Z=-6.236,P<0.001)及脾脏厚度(Z=-2.432,P=0.015)方面高于非PVT组,而TG水平低于非PVT组(Z=-4.150,P<0.001)。多因素分析显示,TG水平(OR=0.441, 95%CI:0.190~0.889)、D-二聚体水平升高(OR=1.151, 95%CI:1.041~1.272)、PT延长(OR=1.160, 95%CI:1.025~1.313)、有脾切除史(OR=2.933, 95%CI:l.164~7.389)是肝硬化食管静脉曲张患者PVT形成的独立风险因素。基于多因素回归结果,建立了列线图,其C指数值为0.745,校准曲线显示PVT发生的观测值和预测值之间有较好的一致性。  结论  TG水平降低、有脾切除史、D-二聚体水平升高、PT延长是肝硬化食管静脉曲张患者PVT形成的独立危险因素,基于此所建立的列线图,为临床医生评估PVT形成风险提供了一个定量、直观的工具。
  • 图  1  预测肝硬化食管静脉曲张患者PVT形成的列线图

    图  2  模型校准图形

    表  1  两组患者一般资料比较

    项目 PVT组(n=119) 非PVT组(n=164) 统计值 P
    性别(例) χ2=0.260 0.650
      男 75 99
      女 44 65
    年龄(岁) 55.87±10.80 54.04±10.9 t=-1.395 0.164
    脾切除史(例) 53 27 χ2=26.805 <0.001
    脾栓塞史(例) 6 4 χ2=1.371 0.242
    普萘洛尔应用史(例) 4 7 χ2=0.152 0.697
    病因(例) χ2=5.051 0.654
      HBV 55 65
      酒精性 23 27
      HBV+酒精性 4 8
      HCV 2 4
      HBV+HCV 0 1
      HCV+酒精性 0 1
      自身免疫性 6 16
      其他 29 42
    Child-Pugh分级(例) χ2=9.388 0.009
      A级 54 90
      B级 48 67
      C级 17 7
    吸烟史(例) 47 57 χ2=0.666 0.414
    饮酒史(例) 40 56 χ2=0.009 0.926
    高血压史(例) 14 23 χ2=0.310 0.578
    糖尿病史(例) 20 23 χ2=0.414 0.520
    下载: 导出CSV

    表  2  两组患者临床资料比较

    项目 PVT组(n=119) 非PVT组(n=164) 统计值 P
    WBC(×109/L) 3.88(3.03~5.67) 3.35(2.41~5.13) Z=-2.248 0.025
    PLT(×109/L) 124.00(64.00~260.00) 77.00(61.25~124.00) Z=-3.323 0.001
    Hb (g/L) 86.00(72.00~107.00) 91.00(74.00~108.00) Z=-0.951 0.341
    Alb (g/L) 33.60(28.78~37.63) 33.70(28.86~38.20) Z=-0.359 0.720
    AST (U/L) 34.50(24.75~45.25) 37.00(26.00~52.00) Z=-1.319 0.190
    ALT (U/L) 22.00(15.00~35.00) 26.00 (17.00~41.00) Z=-1.728 0.110
    TG (mmol/L) 0.75(0.59~1.03) 0.94(0.70~1.28) Z=-4.150 <0.001
    TC (mmol/L) 3.89(2.97~4.65) 3.73(3.05~4.79) Z=-0.085 0.920
    LDL-C (mmol/L) 2.21(1.63~2.80) 2.21(1.68~2.77) Z=-0.056 0.956
    HDL-C (mmol/L) 1.03(0.72~1.38) 1.02(0.81~1.29) Z=-0.223 0.824
    TBil (μmol/L) 18.35(14.88~26.33) 20.10(14.6~28.3) Z=-0.664 0.520
    PT(s) 14.60 (13.60~16.90) 14.30(13.10~15.80) Z=-1.917 0.055
    APTT(s) 36.35(30.68~40.35) 34.35(29.75~39.20) Z=-1.345 0.179
    INR 1.22(1.15~1.35) 1.20(1.10~1.32) Z=-1.789 0.074
    D-二聚体(mg/L) 2.64(1.07~5.70) 0.89(0.40~2.10) Z=-6.236 <0.001
    腹水[例(%)] χ2=6.229 0.101
      无 57 (47.90) 95 (57.93)
      少量 40 (33.61) 48 (29.27)
      中量 10 (8.40) 15 (9.15)
      大量 12 (10.08) 6 (3.66)
    门静脉主干内径(cm) 1.30(1.10~1.50) 1.30(1.20~1.40) Z=-0.286 0.104
    脾脏厚度(mm) 5.50(4.80~6.40) 5.00(4.50~6.00) Z=-2.432 0.015
    食管静脉曲张程度[例(%)] χ2=2.283 0.319
      轻 14 (11.76) 11 (6.71)
      中 17 (14.29) 27 (16.46)
      重 88 (73.95) 126 (76.83)
    肝性脑病[例(%)] 12(10.08) 7(4.27) χ2=5.555 0.135
    下载: 导出CSV

    表  3  多因素logistic回归分析

    变量 B Wald OR 95%CI P
    TG -0.889 5.101 0.411 0.190~0.889 0.024
    D-二聚体 0.141 7.587 1.151 1.041~1.272 0.006
    PT 0.149 5.550 1.160 1.025~1.313 0.018
    脾切除史 1.076 5.209 2.933 1.164~7.389 0.022
    下载: 导出CSV
  • [1] ZOCCO MA, DI STASIO E, de CRISTOFARO R, et al. Thrombotic risk factors in patients with liver cirrhosis: Correlation with MELD scoring system and portal vein thrombosis development[J]. J Hepatol, 2009, 51(4): 682-689. DOI: 10.1016/j.jhep.2009.03.013
    [2] RUAN FM, LI BM. Risk factors for the formation of portal vein thrombosis in patients with liver cirrhosis[J]. J Clin Hepatol, 2020, 36(1): 182-185. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2020.01.043

    阮芳鸣, 李弼民. 肝硬化门静脉血栓形成的危险因素[J]. 临床肝胆病杂志, 2020, 36(1) : 182-185. DOI: 10.3969/j.issn.1001-5256.2020.01.043
    [3] NORONHA FERREIRA C, MARINHO RT, CORTEZ-PINTO H, et al. Incidence, predictive factors and clinical significance of development of portal vein thrombosis in cirrhosis: A prospective study[J]. Liver Int, 2019, 39(8): 1459-1467. DOI: 10.1111/liv.14121
    [4] GUO YL, XU BH, LIU X, et al. Risk factors analysis of early rebleeding after endoscopic treatment of esophageal varices[J]. Chin J Dig Endosc, 2018, 35(2): 89-93. (in Chinese) DOI: 10.3760/cma.j.issn.1007-5232.2018.02.003

    郭雅丽, 徐宝宏, 刘贤, 等. 食管静脉曲张内镜治疗术后早期再出血的危险因素分析[J]. 中华消化内镜杂志, 2018, 35(2): 89-93. DOI: 10.3760/cma.j.issn.1007-5232.2018.02.003
    [5] QI X, SU C, REN W, et al. Association between portal vein thrombosis and risk of bleeding in liver cirrhosis: A systematic review of the literature[J]. Clin Res Hepatol Gastroenterol, 2015, 39(6): 683-691. DOI: 10.1016/j.clinre.2015.02.012
    [6] TARZAMNI MK, SOMI MH, FARHANG S, et al. Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients[J]. World J Gastroenterol, 2008, 14(12): 1898-1902. DOI: 10.3748/wjg.14.1898
    [7] STINE JG, WANG J, SHAH PM, et al. Decreased portal vein velocity is predictive of the development of portal vein thrombosis: A matched case-control study[J]. Liver Int, 2018, 38(1): 94-101. DOI: 10.1111/liv.13500
    [8] Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35(11): 2408-2425. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.11.006

    中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006
    [9] NERY F, CHEVRET S, CONDAT B, et al. Causes and consequences of portal vein thrombosis in 1, 243 patients with cirrhosis: Results of a longitudinal study[J]. Hepatology, 2015, 61(2): 660-667. DOI: 10.1002/hep.27546
    [10] OOI K, SHIRAKI K, SAKURAI Y, et al. Clinical significance of abnormal lipoprotein patterns in liver diseases[J]. Int J Mol Med, 2005, 15(4): 655-660. http://europepmc.org/abstract/MED/15754028
    [11] CHEN S, YIN P, ZHAO X, et al. Serum lipid profiling of patients with chronic hepatitis B, cirrhosis, and hepatocellular carcinoma by ultra fast LC/IT-TOF MS[J]. Electrophoresis, 2013, 34(19): 2848-2856.
    [12] ZHAO J, ZHAO Y, WANG H, et al. Association between metabolic abnormalities and HBV related hepatocelluar carcinoma in Chinese: A cross-sectional study[J]. Nutr J, 2011, 10: 49. DOI: 10.1186/1475-2891-10-49
    [13] FIMOGNARI FL, DE SANTIS A, PICCHERI C, et al. Evaluation of D-dimer and factor Ⅷ in cirrhotic patients with asymptomatic portal venous thrombosis[J]. J Lab Clin Med, 2005, 146(4): 238-243. DOI: 10.1016/j.lab.2005.06.003
    [14] WANG Y, SHI Y, DONG Y, et al. Clinical risk factors of asymptomatic deep venous thrombosis in patients with acute stroke[J]. Clin Appl Thromb Hemost, 2019, 25: 1076029619868534. http://www.researchgate.net/publication/335325676_clinical_risk_factors_of_asymptomatic_deep_venous_thrombosis_in_patients_with_acute_stroke
    [15] ROULEAU P, GUERTIN PA. Early changes in deep vein diameter and biochemical markers associated with thrombi formation after spinal cord injury in mice[J]. J Neurotrauma, 2007, 24(8): 1406-1414. DOI: 10.1089/neu.2006.0260
    [16] OKANO K, SHITAMOTO K, ARAKI M, et al. Influencing factors in quantitative measurement using activated platelet levels and platelet-activating capacity for the assessment of thrombosis in pre-metabolic syndrome and type 2 diabetes mellitus[J]. Nurs Health Sci, 2018, 20(1): 69-78. DOI: 10.1111/nhs.12389
    [17] YANG J, ZHOU X, FAN X, et al. mTORC1 promotes aging-related venous thrombosis in mice via elevation of platelet volume and activation[J]. Blood, 2016, 128(5): 615-624. DOI: 10.1182/blood-2015-10-672964
    [18] ZHOU J, XU E, SHAO K, et al. Circulating platelet-neutrophil aggregates as risk factor for deep venous thrombosis[J]. Clin Chem Lab Med, 2019, 57(5): 707-715. DOI: 10.1515/cclm-2018-0909
    [19] LYU J, DONG SS, GU HT, et al. TCM syndrome characteristics of portal vein thrombosis in patients with liver cirrhosis and related risk factors[J]. J Clin Hepatol, 2019, 35(10): 2210-2213.(in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.10.016

    吕靖, 董思思, 顾宏图, 等. 肝硬化并发门静脉血栓的危险因素及中医证候特点[J]. 临床肝胆病杂志, 2019, 35(10): 2210-2213. DOI: 10.3969/j.issn.1001-5256.2019.10.016
    [20] LI MX, ZHANG XF, LIU ZW, et al. Risk factors and clinical characteristics of portal vein thrombosis after splenectomy in patients with liver cirrhosis[J]. Hepatobiliary Pancreat Dis Int, 2013, 12(5): 512-519. DOI: 10.1016/S1499-3872(13)60081-8
    [21] TRIPODI A, PRIMIGNANI M, CHANTARANGKUL V, et al. An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis[J]. Gastroenterology, 2009, 137(6): 2105-2111. DOI: 10.1053/j.gastro.2009.08.045
    [22] LINARES I, GOLDARACENA N, ROSALES R, et al. Splenectomy as flow modulation strategy and risk factors of de novo portal vein thrombosis in adult-to-adult living donor liver transplantation[J]. Liver Transpl, 2018, 24(9): 1209-1220. DOI: 10.1002/lt.25212
    [23] IKEDA M, SEKIMOTO M, TAKIGUCHI S, et al. High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: A prospective study with contrast-enhanced CT scan[J]. Ann Surg, 2005, 241(2): 208-216. DOI: 10.1097/01.sla.0000151794.28392.a6
    [24] ABDEL-RAZIK A, MOUSA N, ELHELALY R, et al. De-novo portal vein thrombosis in liver cirrhosis: Risk factors and correlation with the Model for End-stage Liver Disease scoring system[J]. Eur J Gastroenterol Hepatol, 2015, 27(5): 585-592. DOI: 10.1097/MEG.0000000000000325
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  • 收稿日期:  2020-08-02
  • 修回日期:  2020-08-31
  • 刊出日期:  2021-01-18
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