失代偿期乙型肝炎肝硬化患者门静脉血栓形成的临床意义

摘要/Abstract

摘要： 目的探讨失代偿期乙型肝炎肝硬化患者门静脉血栓形成(PVT)发生情况及影响因素。方法选择2012年1月至2017年6月HBV-DLC患者242例,伴有PVT 28例(PVT组)、不伴PVT 214例(非PVT组)。行单因素和多因素分析,确定独立预测因素。结果 PVT组年龄55(46,63)岁,非PVT组年龄51(43,59)岁,差异有统计学意义(Z=6.004,P<0.05)。PVT组男性15例(53.6%),非PVT组男性162例(75.7%),差异有统计学意义(χ²=-6.172,P<0.05)。PVT组静脉曲张破裂出血14例(50.0%),非PVT组38例(17.8%),差异有统计学意义(χ²=15.258,P<0.05)。PVT组糖尿病6例(21.4%),非PVT组糖尿病22例(10.3%),差异有统计学意义(χ²=3.008,P<0.05);PVT组总胆红素、INR、D-二聚体、MELD评分、Child-Pugh评分分别为27.8(18.0,53.5)μmol/L、1.4(1.3,1.6)、2.1(1.0,4.9)、12(9,15)分、8(7,10)分,非PVT组分别为95.4(32.5,280.8)μmol/L、1.6(1.3,2.0)、1.2(0.5,2.9)、17(12,24)分、10(8,11)分,差异有统计学意义(Z=-15.635,-6.006、10.581、-9.130、-6.384,均P<0.05)。PVT组脾切除术6例(21.4%),非PVT组糖尿病8例(3.7%),差异有统计学意义(χ²=14.216,P<0.05);PVT组内镜硬化治疗6例(21.4%),非PVT组糖尿病10例(4.7%),差异有统计学意义(χ²=11.259,P<0.05)。而两组患者腹水、WBC、饮酒史、PLT、肌酐及TIPS差异无统计学意义(P>0.05)。年龄、脾切除术及内镜硬化治疗是影响HBV-DLC患者PVT发生的独立危险因素(P<0.05)。结论高龄、脾切除术及内镜硬化治疗与HBV-DLC患者PVT发生有关,临床实践中需加以重视。

关键词: 乙型肝炎病毒, 失代偿期肝硬化, 门静脉血栓形成, 脾切除术, 内镜硬化治疗

Abstract: Objective To investigate the incidence and influencing factors of portal vein thrombosis (PVT) in patients with hepatits B virus related decompensated liver cirrhosis (HBV-DLC).Methods A total of 242 patients with HBV-DLC (164 males and 78 females) admitted to our hospital from January 2012 to June 2017 were enrolled. Among all the patients, there were 28 cases with PVT and 214 cases without PVT, and the average age was (51.6±7.6) years. Univariate analysis and multivariate analysis were performed to determine independent risk factors.Results The ages of PVT group and non-PVT group were 55 (46, 63) and 51 (43, 59) years old, and the difference was statistically significant (Z=6.004, P<0.05). There were 15 males in PVT group (53.6%) and 162 males in non-PVT group (75.7%), and the difference was statistically significant (χ²=-6.172, P<0.05). There were 14 cases (50.0%) and 38 cases (17.8%) with variceal bleeding in PVT group and non-PVT group, with statistically significant (χ²=15.258, P<0.05). There were 6 cases and 22 cases with diabetes mellitus in PVT group (21.4%) non-PVT group (10.3%), the difference was statistically significant (χ²=3.008, P<0.05). Total bilirubin, international normalized ratio (INR), D-dimer, model for end stage liver disease (MELD) score and Child-Pugh score in PVT group were 27.8 (18.0, 53.5) μmol/L, 1.4 (1.3, 1.6), 2.1 (1.0, 4.9), 12 (9, 15) points, 8 (7, 10) points, which were significantly different from those in non-PVT group [95.4(32.5, 280.8) μmol/L, 1.6(1.3, 2.0), 1.2(0.5, 2.9), 17(12, 24) points, 10(8, 11) points], (Z=-15.635, -6.006, 10.581, -9.130 and -6.384, P<0.05). There were 6 cases (21.4%) and 8 cases (3.7%) with splenectomy in PVT group non-PVT group, the difference was statistically significant (χ²=14.216, P<0.05). There were 6 cases (21.4%) and 10 cases (4.7%) with endoscopic sclerotherapy in PVT group and non-PVT group, the difference was statistically significant (P<0.05). There was no significant difference in ascites, white blood cell (WBC), drinking history, platelet (PLT), creatinine and transjugular intrahepatic portosystemic shunt (TIPS) between the 2 groups (P>0.05). Taking all influencing factors with statistical differences as independent variables and the occurrence of PVT in patients with HBV-DLC was regarded as dependent variable (0 = no PVT, 1 = PVT). The results of analysis showed that age, splenectomy and endoscopic sclerotherapy were independent risk factors for PVT in HBV-DLC patients (P<0.05).Conclusion Advanced age, splenectomy and endoscopic sclerotherapy are related to the occurrence of PVT in patients with HBV-DLC, which deserves more clinical attention.

Key words: Hepatitis B virus related decompensated liver cirrhosis, Portal vein thrombosis, Splenectomy, Endoscopic sclerotherapy

王利慧, 王荣希, 赵泽源, 郭振凯. 失代偿期乙型肝炎肝硬化患者门静脉血栓形成的临床意义[J]. 肝脏, 2022, 27(8): 874-876.

WANG Li-hui, WANG Rong-xi, ZHAO Ze-yuan, GUO Zhen-kai. Clinical significance of portal vein thrombosis in patients with HBV related decompensated liver cirrhosis[J]. Chinese Hepatolgy, 2022, 27(8): 874-876.

参考文献

[1] Senzolo M, M Sartori T, Rossetto V, et al. Prospective evaluation of anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis. Liver Int, 2012, 32(6): 919-927.
[2] 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. Liver Int, 2019, 39(8): 1459-1467.
[3] Ai MH, Dong WG, Tan XP, et al. Efficacy and safety study of direct-acting oral anticoagulants for the treatment of chronic portal vein thrombosis in patients with liver cirrhosis. Eur J Gastroenterol Hepatol, 2020, 32(10): 1395-1400.
[4] He FL, Qi RZ, Zhang YN, et al. Transjugular intrahepatic portosystemic shunt and splenectomy are more effective than endoscopic therapy for recurrent variceal bleeding in patients with idiopathic noncirrhotic portal hypertension. World J Clin Cases, 2020, 8(10): 1871-1877.
[5] Cool J, Rosenblatt R, Kumar S, et al. Portal vein thrombosis prevalence and associated mortality in cirrhosis in a nationally representative inpatient cohort. J Gastroenterol Hepatol, 2019, 34(6): 1088-1092.
[6] Fan X, Huang X, Hershman M, et al. Portal vein thrombosis prevalence and mortality among alcoholic cirrhosis in a nationwide inpatient cohort. Eur J Gastroenterol Hepatol, 2020, 32(9): 1160-1167.
[7] Kline K, Al Hanayneh M, Bilal M, Stevenson-Lerner H. Portal vein thrombosis leading to pre-sinusoidal non-cirrhotic portal hypertension resulting in decreased synthetic function of the liver. Gastroenterol Hepatol Bed Bench, 2019, 12(2): 174-177.
[8] Ponthus S, Spahr L, Casini A, et al. Safety of variceal band ligation in patients with cirrhosis and portal vein thrombosis treated with anticoagulant therapy: a retrospective study. Eur J Gastroenterol Hepatol, 2020, 32(3): 395-400.
[9] Pettinari I, Vukotic R, Stefanescu H, et al. Clinical impact and safety of anticoagulants for portal vein thrombosis in cirrhosis. Am J Gastroenterol, 2019, 114(2): 258-266.
[10] Han G,Qi X,He C,et al. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with symptomatic portal hypertension in liver cirrhosis. J Hepatol,2011, 54(1): 78-88.
[11] Maruyama H, Okugawa H, Takahashi M, et al. De novo portal vein thrombosis in virus-related cirrhosis:predictive factors and long-term outcomes. Am J Gastroenterol,2013, 108(4): 568-574.
[12] Zhang Y, Xu BY, Wang XB, et al. Prevalence and clinical significance of portal vein thrombosis in patients with cirrhosis and acute decompensation. Clin Gastroenterol Hepatol, 2020, 18(11): 2564-2572.e1.

[1]	谢志伟, 陆霭琪, 杨可立, 陈彬彬, 关玉娟, 肖光明, 李剑萍. 乙型肝炎病毒相关慢加急性肝衰竭患者血清miRNA差异表达谱及其预后预测价值[J]. 肝脏, 2022, 27(8): 853-857.
[2]	谢巧华, 王巍, 唐龙, 陈佳霖, 苏妙芳, 蔡奇志. 急性肾损伤对失代偿期乙型肝炎肝硬化患者临床预后的影响[J]. 肝脏, 2022, 27(8): 868-870.
[3]	仲小强, 储旭东, 陈海燕, 高太俊. HBV相关慢加急性肝衰竭患者并发细菌感染影响因素及预后结局分析[J]. 肝脏, 2022, 27(7): 748-751.
[4]	张祎, 王舟, 杨斌. IL-17家族细胞因子与慢性乙型肝炎肠道菌群的相关性分析[J]. 肝脏, 2022, 27(7): 759-761.
[5]	阮鹏, 何春萍, 黄超, 周瑞. 改良Alu-PCR技术检测HepG2.2.15细胞HBV整合的研究[J]. 肝脏, 2022, 27(7): 785-788.
[6]	苏雨, 孙小怡, 王倩怡, 赵新颜, 贾继东. 既往乙型肝炎病毒感染对自身免疫性肝炎治疗应答及预后的影响[J]. 肝脏, 2022, 27(7): 789-794.
[7]	刘思佳, 张钰, 曹学冬, 曲岩, 陈佳骏, 张海阳, 罗运权, 宋鑫. 乙型肝炎肝硬化患者脾切除术后复杂并发症1例[J]. 肝脏, 2022, 27(7): 831-832.
[8]	叶丹, 罗新华. 非生物型人工肝支持系统治疗HBV相关慢加急性肝衰竭研究进展[J]. 肝脏, 2022, 27(5): 600-602.
[9]	李亚萍, 刘晨瑞, 翟嵩, 李梅, 冯丹丹, 党双锁. 肝癌患者PD-1抑制剂治疗后T细胞下降伴HBV再激活1例[J]. 肝脏, 2022, 27(5): 610-611.
[10]	陈靖赜, 祁玮, 胡明乐, 李华东, 王静. HBV前基因组RNA水平与慢性乙型肝炎患者停药后复发风险的相关性[J]. 肝脏, 2022, 27(4): 413-417.
[11]	孙继云, 马小艳, 刘欢, 王雅杰. 两种乙型肝炎表面抗原磁微粒化学发光法检测试剂盒性能比较[J]. 肝脏, 2022, 27(4): 418-420.
[12]	卢艳玲, 李小红, 陈海涛. 慢性乙型肝炎患者血清HBV pgRNA与HBV DNA和HBeAg水平变化关系研究[J]. 肝脏, 2022, 27(3): 302-304.
[13]	黄翀, 钟启盛, 鱼康康, 刘传苗. HBV相关慢加急性肝衰竭患者感染危险因素及其对预后影响[J]. 肝脏, 2022, 27(2): 148-151.
[14]	秦旭, 侯志云, 张松, 马丽, 朝浩鹏. S基因突变对慢性乙型肝炎肝硬化患者血清AFP、PTX3表达及预后的影响[J]. 肝脏, 2022, 27(2): 178-181.
[15]	崔大广, 肖玲燕, 刘永福, 史东阳, 杨凯, 郑以山. CTP-MELD评分联合血清M30和M65预测乙型肝炎相关慢加急性肝衰竭短期预后的价值[J]. 肝脏, 2022, 27(1): 58-62.