血栓弹力图对乙型肝炎肝硬化患者脾切除术后门静脉血栓形成的预测意义

摘要/Abstract

摘要： 目的探讨血栓弹力图(thromboelastography, TEG)参数在预测乙型肝炎肝硬化患者脾切除术后门静脉血栓形成的价值及其相关影响因素。方法本研究回顾性选取2022年1月至2024年6月在达州市中西医结合医院进行脾切除术治疗的114例乙型肝炎肝硬化患者为研究对象,根据患者术后是否形成门静脉血栓分为血栓组(n=63)与无血栓组(n=51)。收集上述研究对象相关临床资料,采用logistic多因素回归分析乙型肝炎肝硬化患者脾切除术后门静脉血栓形成的影响因素,采用受试者工作曲线(ROC曲线)分析TEG参数对乙型肝炎肝硬化患者脾切除术后门静脉血栓形成的预测价值。结果在乙型肝炎肝硬化患者脾切除术后,血栓组术前脾静脉直径、输血量、术后脾静脉直径及术后第1、3、5天的FIB、α角、MA值分别为(1.45±0.42) cm、(454.67±39.43) mL、(1.21±0.32) cm、(3.98±1.21) g/L、(4.21±1.42) g/L、(3.94±1.65) g/L、(65.32±6.48)°、(71.04±7.32)°、(64.31±5.34)°、(57.34±6.15) mm、(63.34±6.34) mm、(56.10±6.15) mm,均显著高于非血栓组(P<0.05)。血栓组术前血小板、术前DD、术前及术后门静脉流速、术后第1、3、5天的TT、APTT、PT、D-D、K、R值分别为(56.02±13.81)×10⁹/L、(377.94±38.65) μg/L、(15.45±3.34) cm/s、(11.59±3.02) cm/s、(13.87±1.85) s、(11.98±1.32) s、(14.01±1.62) s、(32.84±2.78) s、(26.89±2.67) s、(31.69±2.11) s、(12.02±2.64) s、(10.67±1.84) s、(13.05±2.08) s、(2.01±0.81) mg/L、(2.79±0.95) mg/L、(1.68±0.66) mg/L、(3.07±1.11) min、(1.98±0.74) min、(2.73±1.04) min、(4.42±0.98) min、(3.79±0.81) min、(4.19±0.89) min,均显著低于非血栓组(P<0.05)。logistic回归分析显示,术前脾静脉直径和α角是术后门静脉血栓形成的独立危险因素(OR=5.771、1.392),术前血小板、术前门静脉流速、K、R、MA是独立保护因素(OR=0.948、0.683、0.407、0.365、0.210)。TEG参数中α角对血栓形成的预测价值最高,灵敏度82.5%,特异度82.4%,AUC为0.865,联合检测灵敏度和特异度分别达到90.5%和94.1%,AUC为0.963。结论 TEG参数中的α角和MA指标是预测乙型肝炎肝硬化患者脾切除术后门静脉血栓形成的重要指标。本研究证实,术前脾静脉直径及术后TEG参数如α角、K、R和MA均为乙型肝炎肝硬化患者脾切除术后门静脉血栓形成的独立影响因素。联合应用这些TEG参数可提高门静脉血栓形成的预测精度,为临床提供更有效的风险评估与管理策略。

关键词: 乙型肝炎, 肝硬化, 脾切除术, 门静脉血栓, 血栓弹力图, 预测模型

Abstract: Objective To explore the value of thromboelastography (TEG) parameters in predicting portal vein thrombosis (PVT) after splenectomy in patients with hepatitis B-related cirrhosis and to identify related influencing factors. Methods This retrospective study included 114 patients with hepatitis B-related cirrhosis who underwent splenectomy at Dazhou integrated TCM & Western Medicine Hospital from January 2022 to June 2024. Patients were divided into thrombosis group (n=63) and non-thrombosis group (n=51) based on postoperative PVT occurrence. Clinical data were collected for analysis. Logistic multivariate regression analysis was used to determine factors influencing PVT formation after splenectomy. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of TEG parameters for PVT formation. Results In patients with hepatitis B-related cirrhosis undergoing splenectomy, preoperative splenic vein diameter, intraoperative transfusion volume, postoperative splenic vein diameter, and fibrinogen levels on days 1, 3, and 5 postoperatively were 1.45±0.42 cm, 454.67±39.43 mL, 1.21±0.32 cm, 3.98±1.21 g/L, 4.21±1.42 g/L, and 3.94±1.65 g/L, respectively. Alpha angles and maximum amplitude (MA) values were 65.32±6.48°, 71.04±7.32°, 64.31±5.34°, 57.34±6.15 mm, 63.34±6.34 mm, and 56.10±6.15 mm, respectively. All these parameters were significantly higher in the thrombosis group compared to the non-thrombosis group (P<0.05). Preoperative platelet count, preoperative D-dimer, and pre- and postoperative portal vein flow velocities in the thrombosis group were 56.02±13.81×10⁹/L, 377.94±38.65 μg/L, 15.45±3.34 cm/s, and 11.59±3.02 cm/s, respectively. Thrombin time (TT), activated partial thromboplastin time (APTT), prothrombin time (PT), and D-dimer on days 1, 3, and 5 postoperatively were 13.87±1.85 s, 11.98±1.32 s, 14.01±1.62 s, 32.84±2.78 s, 26.89±2.67 s, 31.69±2.11 s, 12.02±2.64 s, 10.67±1.84 s, and 13.05±2.08 s, respectively. Postoperative D-dimer concentrations on days 1, 3, and 5 were 2.01±0.81 mg/L, 2.79±0.95 mg/L, and 1.68±0.66 mg/L, respectively. Coagulation indices K and R values were 3.07±1.11 min, 1.98±0.74 min, 2.73±1.04 min, 4.42±0.98 min, 3.79±0.81 min, and 4.19±0.89 min, respectively. These parameters were significantly lower in the thrombosis group than in the non-thrombosis group (P<0.05). Logistic regression analysis revealed that preoperative splenic vein diameter and α-angle were independent risk factors for postoperative portal vein thrombosis (OR=5.771, 1.392), while preoperative platelet count, preoperative portal vein velocity, K, R, and MA were independent protective factors (OR=0.948, 0.683, 0.407, 0.365, 0.210). Among the thromboelastography (TEG) parameters, the α-angle demonstrated the highest predictive value for thrombosis, with a sensitivity of 82.5%, specificity of 82.4%, and an area under the curve (AUC) of 0.865. Combined detection achieved a sensitivity of 90.5% and a specificity of 94.1%, with an AUC of 0.963. Conclusion The TEG parameters α-angle and MA are important indicators for predicting PVT formation after splenectomy in patients with hepatitis B-related cirrhosis. This study confirms that preoperative splenic vein diameter and postoperative TEG parameters such as α-angle, K, R, and MA are independent factors influencing PVT formation. The combined use of these TEG parameters can enhance the accuracy of PVT predictions, thus providing more effective risk assessment and management strategies in clinical practice.

Key words: Hepatitis B, Cirrhosis, Splenectomy, Portal Vein Thrombosis, Thromboelastography, Predictive Model

熊德琼, 彭德川, 谯从超. 血栓弹力图对乙型肝炎肝硬化患者脾切除术后门静脉血栓形成的预测意义[J]. 肝脏, 2025, 30(4): 519-524.

XIONG De-qiong, PENG De-chuan, QIAO Cong-chao. The predictive significance of thromboelastography for portal vein thrombosis after splenectomy in patients with hepatitis B-related cirrhosis[J]. Chinese Hepatolgy, 2025, 30(4): 519-524.

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