肝硬化门静脉高压术后血栓风险与术前超声血流参数及凝血功能指标的关系  

Relationship of postoperative portal vein thrombosis risk with ultrasound blood flow parameters and coagulation function in patients with cirrhosis and portal hypertension

作　　者：解敬伟 谢丽娟 田玉晶 李天成[1] 宋诏民[4] 李肖云[5] 郭旺盛[1] Xie Jingwei;Xie Lijuan;Tian Yujing;Li Tiancheng;Song Zhaomin;Li Xiaoyun;Guo Wangsheng(Department of Surgery,The Third Hospital of Qinhuangdao,Qinhuangdao 066000,China;Department of Physical Examination,The Third Hospital of Qinhuangdao,Qinhuangdao 066000,China;Public Health Section,The Third Hospital of Qinhuangdao,Qinhuangdao 066000,China;Department of Oncology,The Third Hospital of Qinhuangdao,Qinhuangdao 066000,China;Department of Physiotherapy,The Third Hospital of Qinhuangdao,Qinhuangdao 066000,China)

机构地区：[1]河北省秦皇岛市第三医院外一科,秦皇岛066000 [2]河北省秦皇岛市第三医院体检科,秦皇岛066000 [3]河北省秦皇岛市第三医院公共卫生科,秦皇岛066000 [4]河北省秦皇岛市第三医院肿瘤科,秦皇岛066000 [5]河北省秦皇岛市第三医院理疗科,秦皇岛066000

出　　处：《广西医科大学学报》2019年第6期915-918,共4页Journal of Guangxi Medical University

基　　金：河北省秦皇岛市科学技术局课题资助项目(No.201703A048)

摘　　要：目的:探讨肝硬化门静脉高压患者术后门静脉血栓(PVT)与术前超声血流参数及凝血功能指标的关系。方法:对2016年1月至2018年1月在河北省秦皇岛市第三医院接受手术治疗的102例肝硬化门静脉高压患者进行回顾性分析,根据术后是否形成PVT,将患者划分为血栓组(33例)和非血栓组(69例)。对可能导致PVT形成的因素进行单因素及多因素分析,通过受试者工作特征(ROC)曲线分析各独立影响因素对预测术后PVT形成的效能。结果:血栓组出血病史比率、术前门静脉血流速度、尿素氮及D-二聚体水平明显高于非血栓组,术前门静脉直径明显长于非血栓组,差异均有统计学意义(均P<0.05)。伴出血病史、较高水平的D-二聚体是患者术后PVT形成的独立危险因素(OR=2.224、1.211,P<0.05),而较高的门静脉血流速度是患者术后PVT形成的独立保护因素(OR=0.570,P<0.05)。术前门静脉血流速度及D-二聚体对预测术后PVT形成的ROC曲线下面积(AUC)分别为0.766、0.754,最佳截断值分别为13.85cm/s、2.75mg/L。结论:对肝硬化门静脉高压患者,术前检测门静脉血流速度及D-二聚体水平,有助于识别术后PVT高危人群。Objective: To investigate the relationship between postoperative portal vein thrombosis (PVT) and preoperative ultrasound blood flow parameters or coagulation function in patients with cirrhosis and portal hypertension. Methods: A retrospective analysis was conducted in 102 patients with cirrhosis and portal hypertension treated in our hospital from January 2016 to January 2018.The patients were divided into thrombus group (33 cases) and non-thrombus group (69 cases) according to whether the PVT occurred after operation.Univariate and multivariate analysis were used to analyze the risk factors for the formation of the PVT.The value of these factors for predicting PVT was evaluated by receiver operating characteristic (ROC) curve. Results: The number of patients with upper gastric bleeding history in the thrombus group was much more than that in the non-thrombus group,preoperative portal vein diameter was longer,preoperative portal vein velocity was lower,and the levels of urea nitrogen and D-dimer were significantly higher ( P < 0.05).A history of upper gastric bleeding and a higher level of D-dimer were the independent risk factors of PVT after operation ( OR =2.224 and 1.211, P <0.05),whereas a higher portal vein velocity before operation was an independent protective factor of PVT after operation ( OR =0.570, P < 0.05).The area under the ROC curve of preoperative portal vein velocity and D-dimer for predicting PVT were 0.766 and 0.754 with the cut-off value of 13.85 cm/s and 2.75 mg/L,respectively. Conclusion: Preoperative detection of portal vein velocity and D-dimer level is helpful to identify the high risk of PVT in cirrhotic patients with portal hypertension.

关 键 词：肝硬化 门静脉高压 门静脉血栓 危险因素 

分 类 号：R657.34[医药卫生—外科学]