Ⅱ型布加综合征患者血栓形成影响因素及介入治疗疗效观察

摘要/Abstract

摘要： 目的分析Ⅱ型布加综合征(BCS)血栓形成影响因素及介入治疗疗效。方法回顾分析2005年1月—2020年1月期间四川大学华西医院资阳医院诊断并成功接受介入治疗的Ⅱ型BCS患者106例,其中男66例、女40例,年龄(45.4±10.4)岁;BCS治疗包括经导管尿激酶溶栓术、球囊扩张术或支架置入术,根据是否合并血栓进行分组。对纳入病例进行单因素、多因素分析,定期随访并作介入治疗前后疗效评价。结果 106例Ⅱ型BCS患者中合并血栓17例(血栓组)、未合并血栓89例(非血栓组)。血栓组年龄[50(43,67)岁]显著高于非血栓组[44(37,62)岁,P<0.05];血栓组腹胀、腹水为10例(58.8%)、9例(52.9%),分别显著高于非血栓组[29例(32.6%)、21例(23.6%),P<0.05];血栓组WBC、ALT、AST、TBil、Alb、PTA及纤维蛋白原为5.7(4.4,7.1)×10⁹/L、77(52,146)U/L、74(60,135)U/L、36.4(23.4,78.6)μmol/L、34(28,37)g/L、66(63,70)%及5.2(3.4,7.0)g/L,分别与非血栓组[4.3(3.0,6.5)×10⁹/L、24(15,80)U/L、31(18,76)U/L、25.2(16.8,44.0)μmol/L、39(35,46)g/L、75(70,78)%及2.9(2.6,6.0)g/L]比较,差异具有统计学意义(P<0.05);血栓组[7.3(6.0,9.2)分]Child-Pugh评分显著高于非血栓组[6.4(4.8,7.0)分,P<0.05]。将上述差异有统计学意义的各项因素纳入多因素分析,显示年龄、WBC、TBil及Alb是Ⅱ型BCS合并血栓形成的独立影响因素。17例合并血栓Ⅱ型BCS患者中血栓完全、部分溶解14例、3例,IVC血流通畅。IVC-右心房压差由术前[19(14,27)cmH₂O]显著下降至术后[5(3,8)cmH₂O,P<0.05]。随访1～40个月,死亡1例、IVC再狭窄2例,经再次球囊扩张治疗成功。结论年龄、WBC、TBil是Ⅱ型BCS患者血栓形成的独立危险因素,而Alb为保护性因素。介入治疗Ⅱ型BCS合并血栓形成复发率低,远期治疗疗效满意。

关键词: 布加综合征, 下腔静脉, 血栓, 多因素分析

Abstract: Objective To investigate the influencing factors of inferior vena cava (IVC) thrombosis in patients with type Ⅱ Budd-Chiari syndrome(BCS) and observe the curative effect of interventional therapy. Methods From January 2005 to January 2020, 106 patients with type Ⅱ BCS successfully treated by interventional therapy in our hospital were analyzed, including 66 males and 40 females, aged (45.4±10.4) years. They were divided into groups based on the presence or absence of thrombus. The treatment encompassed urokinase thrombolysis via catheter, balloon dilatation or stent implantation. The clinical data of patients with or without type Ⅱ BCS were analyzed by univariate and multivariate analysis. The patients were followed up and the effectiveness of the interventional therapy was assessed by comparing the patients conditions before and after interventional. Results Out of the 106 patients with type Ⅱ BCS, 17 cases were complicated by thrombus formation (Group A), while the remaining 89 cases exhibited no such complication(Group B). The median age in Group A [50 (43, 67) years old] was significantly higher than that of Group B [44 (37, 62) years old, P<0.05]. Abdominal distension and ascites in Group A were 10 cases (58.8%) and 9 cases (52.9%) respectively, which were significantly higher than those in Group B[29 cases (32.6%) and 21 cases (23.6%) respectively, P<0.05]. The median levels of WBC, ALT, AST, TBil, Alb, PTA and fibrinogen in Group A were 5.7 (4.4, 7.1) ×10⁹/L, 77 (52, 146) U/L, 74 (60, 135) U/L, 36.4 (23.4, 78.6) μmol/L, 34 (28, 37) g/L, 66 (63, 70) % and 5.2 (3.4, 7.0) g/L respectively. When compared with those in Group B[4.3 (3.0, 6.5) × 10⁹/L, 24 (15, 80) U/L, 31 (18, 76) U/L, 25.2 (16.8, 44.0) mol/L, 39 (35, 46) g/L, 75(70, 78) % and 2.9 (2.6, 6.0) g/L], The differences were statistically significant(P<0.05). The Child-Pugh scores of Group A and Group B were 7.3 (6.0, 9.2) points and 6.4 (4.8, 7.0) points respectively, the difference being statistically significant (P<0.05). Significant factors(P<0.05) were further subjected to multivariate analysis, revealing age, WBC count, TBil and Alb as statistically distinct from other factors(P<0.05), thus deeming them as independent influencers of type Ⅱ BCS complicated by thrombosis. Among the 17 patients with type Ⅱ BCS complicated by thrombus, 14 cases experienced complete dissolution, 3 showed partial dissolution, and in all patients, unobstructed IVC blood flow was achieved. The pressure difference between the IVC and right atrium significantly decreased from the preoperative measure[19 (14, 27) cmH₂O] to the postoperative measure[5 (3, 8) cmH₂O, P<0.05]. In a follow-up period ranging from 1 to 40 months, there was one death; two cases of IVC restenosis were successfully managed with additional balloon dilatation again. Conclusion Age, WBC and TBil serve as independent risk factors for thrombosis in patients with type Ⅱ BCS, while Alb is a protective factor. The recurrence rate for thrombosis in patients with type Ⅱ BCS who undergo interventional therapy is low, indicating a satisfactory long-term therapeutic outcome.

Key words: Budd-Chiari syndrome, Inferior vena cava, Thrombus, Multivariate analysis

高艳梅, 张惠玲, 雷文芳. Ⅱ型布加综合征患者血栓形成影响因素及介入治疗疗效观察[J]. 肝脏, 2023, 28(7): 837-839.

GAO Yan-mei, ZHANG Hui-ling, LEI Wen-fang. Factors affecting thrombus formation and efficacy of interventional therapy in patients with type II Budd-Chiari syndrome[J]. Chinese Hepatolgy, 2023, 28(7): 837-839.

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