不同程度肝硬化门静脉血栓的临床特点及意义

聂巍; 林伟; 梁珊; 范作鹏; 仇丽霞; 刘义荣; 马丽霞; 韦新焕; 胡中杰; 张晶

doi:10.3969/j.issn.1001-5256.2017.03.015

不同程度肝硬化门静脉血栓的临床特点及意义

DOI: 10.3969/j.issn.1001-5256.2017.03.015

首都医科大学附属北京佑安医院丙肝与中毒性肝病科

基金项目:

艾滋病和病毒性肝炎等重大传染病防治科技重大专项(2016ZX10004906);艾滋病和病毒性肝炎等重大传染病防治科技重大专项(2016ZX10002007-006)；北京市朝阳区艾滋病和病毒性肝炎等重大传染病综合示范区建设研究(2012ZX10004-904)；丰台区科技新星计划项目；

详细信息

中图分类号: R575.2
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出版历程
- 出版日期: 2017-03-20

Clinical features of cirrhotic patients with different degrees of portal vein thrombosis and their clinical significance

Department of Hepatitis C & Toxic Liver Diseases, Beijing YouAn Hospital, Capital Medical University

Research funding:

摘要

摘要: 目的探讨不同严重程度门静脉血栓（PVT）肝硬化患者的肝功能及门静脉高压并发症的临床特点,明确PVT的临床意义。方法回顾性收集2014年1月-2015年6月首都医科大学附属北京佑安医院收治的肝硬化合并PVT患者178例,根据血栓严重程度分为单支血栓组（n=109）和多支血栓组（n=69）。记录患者的病因、临床表现、实验室结果及胃镜检查结果。符合正态分布的计量资料组间比较采用t检验,不符合正态分布的计量资料组间比较采用Wilcoxon秩和检验,计数资料组间比较采用χ2检验。结果单支血栓组中乙型肝炎肝硬化患者比例明显低于多支血栓组（50.5%vs 71.0%,χ2=7.350,P=0.008）,单支血栓组自身免疫性肝硬化比例明显高于多支血栓组（11.0%vs 0,χ2=8.145,P=0.004）;单支血栓组的PTA水平低于多支血栓组[（63.58±21.12）%vs（71.84±16.68）%,t=-2.701,P=0.008];单支血栓组食管静脉曲张重度比例显著低于多支血栓组（57.7%vs81.1%,χ2
- 肝硬化 /
- 静脉血栓形成 /
- 高血压,门静脉
Abstract: Objective To investigate liver function and clinical features of portal hypertension complications in cirrhotic patients with different degrees of PVT, and to clarify the clinical significance of PVT.Methods A retrospective analysis was performed for 178 cirrhotic patients with PVT who were admitted to Beijing You An Hospital, Capital Medical University, from January 2014 to June 2015, and according to the severity of thrombosis, they were divided into single thrombosis group (109 patients) and multiple thrombosis group (69 patients) .The etiology, clinical manifestation, laboratory results, and gastroscopic findings were recorded.The t-test was used for comparison of normally distributed continuous data, the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.Results Compared with the multiple thrombosis group, the single thrombosis group had a significantly lower proportion of patients with hepatitis B cirrhosis than the multiple thrombosis group (50.5% vs 71.0%, χ2=7.350, P=0.008) and a significantly higher proportion of patients with autoimmune cirrhosis (11.0% vs0, χ2=8.145, P=0.004) .Compared with the multiple thrombosis group, the single thrombosis group had significantly lower prothrombin time activity (63.58%±21.12% vs 71.84%±16.68%, t=-2.701, P=0.008) and significantly lower proportions of patients with severe esophageal varices (57.7% vs 81.1%, χ2=8.921, P=0.012) and red-color sign of esophageal varices (64.1% vs 86.8%, χ2=8.298, P=0.005) .Conclusion Multiple PVT does not influence patients' liver function, and patients with multiple PVT have marked esophageal varices compared with those with single PVT.
- liver cirrhosis /
- venous thrombosis /
- hypertension

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参考文献(14)

[1]TIAN F, WANG Y, XIE Y, et al.Clinical analysis of 29 liver cirrhosis patients with portal vein thrombosis[J].Chin Hepatol, 2011, 16 (3) :190-192. (in Chinese) 田丰, 王媛, 解莹, 等.肝硬化患者门静脉系统血栓形成29例分析[J].肝脏, 2011, 16 (3) :190-192.

[2]QI X, HAN G, YE C, et al.Splenectomy causes 10-fold increased risk of portal venous system thrombosis in liver cirrhosis patients[J].Med Sci Monit, 2016, 19 (22) :2528-2550.

[3]WANG WQ, WEN MY, FAN XL, et al.Research advances in liver cirrhosis complicated by portal vein thrombosis[J].J Clin Hepatol, 2016, 32 (7) :1075-1078. (in Chinese) 王万琴, 文茂瑶, 凡小丽, 等.肝硬化合并门静脉血栓的研究进展[J].临床肝胆病杂志, 2016, 32 (7) :1075-1078.

[4]QI X, HAN G, FAN D.Management of portal vein thrombosis in liver cirrhosis[J].Nat Rev Gastroenterol Hepatol, 2014, 11 (7) :435-446.

[5]GAO F, HU FR, QI XS.An excerpt of 2015 EASL clinical practical guidelines:vascular diseases of the liver[J].J Clin Hepatol, 2016, 32 (1) :40-43. (in Chinese) 高帆, 胡凤蓉, 祁兴顺.《2015年欧洲肝病学会临床实践指南:肝脏血管病》摘译[J].临床肝胆病杂志, 2016, 32 (1) :40-43.

[6]WU H, SHOU Y.CT appearance and differential diagnosis of thrombus in portal vein[J].Shanghai Med Imaging, 2004, 13 (4) :296-298. (in Chinese) 吴恒, 寿毅.门静脉血栓的CT表现及鉴别诊断[J].上海医学影像, 2004, 13 (4) :296-298.

[7]Committee of Esophageal Varicosity, Society of Digestive Endoscopy of Chinese Medical Association.Tentative guidelines for endoscopic diagnosis and treatment of varicosity and variceal bleeding in digestive tract[J].China Contin Med Educ, 2010, 2 (6) :21-26. (in Chinese) 中华医学会消化内镜学分会食管胃静脉曲张学组.消化道静脉曲张及出血的内镜诊断和治疗规范试行方案 (2009年) [J].中国继续医学教育, 2010, 2 (6) :21-26.

[8]SARIN SK, PHILIPS CA, KAMATH PS, et al.Toward a comprehensive new classification of portal Vein thrombosis in patients with cirrhosis[J].Gastroenterology, 2016, 151 (4) :574-577, e573.

[9]LIU XR, LIU LX.Updates in the research of portal vein thrombosis in patients with cirrhosis and portal hypertension after splenectomy[J].Chin J Digest Surg, 2015, 14 (2) :170-172. (in Chinese) 刘熙瑞, 刘连新.肝硬化门静脉高压症脾切除术后门静脉血栓形成的研究进展[J].中华消化外科杂志, 2015, 14 (2) :170-172.

[10]WU CS, ZHANG L, ZHOU W, et al.A clinical observation of hepatic vein pressure gradient and flow rate after Octreotide treatment of bleeding esophageal varices[J].Chin J Clin Pharmacol Ther, 2015, 20 (4) :441-444. (in Chinese) 吴春松, 张玲, 周玮, 等.奥曲肽治疗对食管胃底静脉曲张出血的肝静脉压力梯度及血流速度的影响观察[J].中国临床药理学与治疗学, 2015, 20 (4) :441-444.

[11]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.

[12]STINE J, SHAH P, CORNELLA S, et al.Portal vein thrombosis, mortality and hepatic decompensation in patients with cirrhosis:a meta-analysis[J].World J Hepatol, 2015, 7 (27) :2774-2780.

[13]BORJAS-ALMAGUER O, CORTEZ-HERNANDEZ C, GONZALEZ-MORENO E, et al.Portal vein thrombosis in patients with cirrhosis:just a common finding or a predictor of poor outcome?[J].Ann Hepatol, 2016, 15 (6) :902-906.

[14]GIRLEANU I, STANCIU C, COJOCARIU C, et al.Natural course of nonmalignant partial portal vein thrombosis in cirrhotic patients[J].Saudi J Gastroenterol, 2014, 20 (5) :288-292.

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