肝硬化患者门静脉血栓形成的临床表现和危险因素  

Clinical manifestations of portal vein thrombosis and related risk factors in patients with liver cirrhosis

作　　者：周仁华[1,2] 李鹏[2] 张艳婷[2] 杨花[2] 杨少奇[2] 

机构地区：[1]宁夏医科大学,银川750004 [2]宁夏医科大学总医院消化内科,银川750004

出　　处：《临床肝胆病杂志》2016年第2期275-278,共4页Journal of Clinical Hepatology

摘　　要：目的研究肝硬化患者门静脉血栓(PVT)形成的临床表现及危险因素。方法收集2008年4月-2015年4月宁夏医科大学总医院收治的肝硬化患者资料541例。其中76例肝硬化合并PVT的患者为研究组,同阶段通过匹配患者的性别、年龄及肝功能Child-Pugh分级,76例肝硬化不合并PVT为对照组。对比分析两组患者的临床资料及相关检查指标。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,并应用非条件Logistic回归模型筛选肝硬化PVT形成的独立危险因素。结果肝硬化PVT患者中,42.1%(32/76)隐匿起病,57.9%(44/76)有明显临床表现。大部分患者肝功能分级为Child-Pugh B和C级。血小板、血糖、中性粒细胞百分比、重度食管胃底静脉曲张、血浆D-二聚体、门静脉宽度、脾脏厚度在两组患者中差异有统计学意义(P值均<0.05)。进一步非条件Logistic回归模型分析显示中性粒细胞百分比[比值比(OR)=1.044,P=0.040]、血浆D-二聚体(OR=0.091,P<0.001)、门静脉宽度(OR=0.030,P=0.008)、脾脏厚度(OR=0.427,P=0.003)为PVT形成的危险因素。结论肝硬化PVT可隐匿起病,也可伴有不同的临床表现。肝硬化PVT常发生在晚期肝硬化患者中,血浆D-二聚体、门静脉宽度、脾脏厚度、中性粒细胞百分比为肝硬化PVT形成的独立危险因素。Objective To investigate the clinical manifestations of portal vein thrombosis （PVT） and related risk factors in patients with liv- er cirrhosis. Methods A total of 541 patients with liver cirrhosis who were admitted to the General Hospital of Ningxia Medical University from April 2008 to April 2015 were included in the study; 76 patients with PVT were enrolled in the study group, and another 76 patients without PVT matched for sex, age, and Child - Pugh class were enrolled in the control group. The clinical data and related indicators were analyzed and compared between the two groups. The t - test was applied for comparison of continuous data between groups, the ehi - square test was applied for comparison of categorical data between groups, and the unconditional logistic regression model was used to determine the independent risk factors for PVT in liver cirrhosis. Results In the patients with liver cirrhosis and PVT, 42. 1% （32/76） had an insidious onset and 57. 9% （44/76） had obvious clinical manifestations. Most patients had Child -Pugh class B and C cirrhosis. There were signifi- cant differences between the two groups in platelet count, blood glucose, percentage of neutrophils, severe esophageal and gastric varices, plasma D - dimer, portal vein width, and thickness of the spleen （ all P 〈 0.05 ）. The unconditional logistic regression model analysis showed that percentage of neutrophils （ OR = 1. 044, P = 0.040）, plasma D - dimer （ OR = 0. 091, P = 0.000）, portal vein width （ OR = 0. 030, P =0. 008）, and thickness of the spleen （ OR = 0.427, P = 0.003 ） were the influencing factors for PVT. Conclusion PVT may have an insidious onset in patients with liver cirrhosis, or have different clinical manifestations. Cirrhotic PVT usually occurs in patients with advanced liver cirrhosis, and plasma D -dimer, portal vein width, thickness of the spleen, and percentage of neutrophils are the independ- ent influencing factors for PVT in patients with liver cirrhosis.

关 键 词：肝硬化 静脉血栓形成 门静脉 危险因素 

分 类 号：R575.2[医药卫生—消化系统]