肝硬化腹腔积液感染并门静脉血栓形成危险因素及其评估模型预测价值  

Risk factors of portal venous thrombosis in cirrhosis patients with ascites infection and the predictive value of evaluation model

作　　者：胡利萍[1] 熊静平[2] 努力比亚·阿不都克尤木[1] 张跃新[1] Hu Liping;Xiong Jingping;Nulibiya Abudukeyoumu;Zhang Yuexin(Department of Infection,the First Affiliated Hospital of Xinjiang Medical Universityt Urumqi 830054,China;the Second Department of Gastroenterology, the Second Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆医科大学第一附属医院感染科,乌鲁木齐830054 [2]新疆医科大学第二附属医院消化二科,乌鲁木齐830000

出　　处：《中国医药》2019年第10期1524-1527,共4页China Medicine

基　　金：新疆维吾尔自治区自然科学基金(2015211C048)~~

摘　　要：目的探讨肝硬化腹腔积液感染并门静脉血栓(PVT)的危险因素及其评估模型的预测价值。方法选取2015年3月至2018年3月新疆医科大学第一附属医院确诊为肝硬化腹腔积液感染的患者388例。将研究对象分为对照组(无PVT,350例)和观察组(合并PVT,38例)。采集患者的实验室及影像学检查结果,比较相关并发症发生情况,筛选出相关的影响因素,建立Logit评估模型,检验预测价值。结果观察组白细胞计数明显高于对照组,血小板分布宽度(PDW)、血红蛋白、γ-谷氨酰转肽酶(γ-GT)、白蛋白水平明显低于对照组(均P <0. 05)。观察组门静脉主干内径、脾静脉内径、腹腔积液量均明显大于对照组[(12±5) mm比(11±5) mm、(9. 7±2. 6) mm比(8. 0±2. 3) mm、(4. 1±2. 2) ml比(2. 4±1. 3) ml](均P <0. 05)。观察组自发性腹膜炎、门静脉高压性胃病(PHG)、食管胃底静脉曲张、上消化道出血(UGIB)的发生率均明显高于对照组(均P <0. 05)。Logistic回归分析结果提示PHG、UGIB、γ-GT、PDW是肝硬化腹腔积液感染并PVT形成的危险因素。建立评估模型:Logit P=2. 031-0. 025×γ-GT(U/L)+0. 35×PDW(mm)+1. 912×PHG(是=1,否=0)+1. 713×UGIB(是=1,否=0);方程准确率为82. 372%。结论γ-GT降低可使肝硬化腹腔积液感染合并PVT的可能性降低,PDW、PHG、UGIB这些危险因素可使肝硬化腹腔积液感染合并PVT的可能性增加,建立Logit评估模型具有较高的预测价值。Objective To investigate the risk factors of portal venous thrombosis( PVT) in cirrhosis patients with ascites infection and the predictive value of evaluation model. Methods Totally 388 cases of cirrhosis with ascites infection were enrolled from March 2015 to March 2018 in the First Affiliated Hospital of Xinjiang Medical University;38 patients with PVT were observation group and 350 patients without PVT were control group.Laboratory indicators,imaging findings and complications were recorded to analyze the influence factors of PVT and to obtain a Logit equation;the predictive value of Logit model was evaluated. Results White blood cell count in observation group was significantly higher and platelet distribution width( PDW),hemoglobin,γ-glutamyl transferase(γ-GT) and albumin levels were significantly lower than those in control group( all P <0. 05). Internal diameter of main portal vein,internal diameter of splenic vein and volume of peritoneal effusion in observation group were significantly greater than those in control group[( 12 ± 5) mm vs( 11 ± 5) mm,( 9. 7 ± 2. 6) mm vs( 8. 0 ± 2. 3) mm,( 4. 1 ±2. 2) ml vs( 2. 4 ±1. 3) ml]( all P <0. 05). Incidences of spontaneous peritonitis,portal hypertensive gastropathy( PHG),esophageal and gastric varices,upper gastrointestinal bleeding( UGIB) in observation group were significantly higher than those in control group( all P < 0. 05). Logistic regression showed that PHG,UGIB,γ-GT and PDW were risk factors of PVT. Logit P = 2. 031-0. 025 ×γ-GT( U/L)+ 0. 35 × PDW( mm)+ 1. 912 × PHG( yes = 1,no = 0)+1. 713 × UGIB( yes = 1,no = 0);the accuracy of equation was 82. 372%. Conclusions Reduction of γ-GT can reduce the incidence of PVT in cirrhosis patients with ascites infection. PHG and UGIB may increase the risk of cirrhotic ascites infection with PVT. Logit model shows a good predictive value for PVT.

关 键 词：肝硬化腹腔积液感染 门静脉血栓 危险因素 评估模型 

分 类 号：R575.2[医药卫生—消化系统]