乙肝肝硬化患者门静脉宽度与门静脉血栓形成的关系  

Relationship between portal vein width and portal vein thrombosis in patients with hepatitis B cirrhosis

作　　者：赵静[1] 李建如 张爱军 李晓蕾[1] 梁剑 郑爱平[1] Jing Zhao;Jian-Ru Li;Ai-Jun Zhang;Xiao-Lei Li;Jian Liang;Ai-Ping Zheng(Department of Ultrasound,Tianjin Beichen Hospital,Tianjin 300400,China)

机构地区：[1]天津市北辰医院超声科,天津300400

出　　处：《世界华人消化杂志》2022年第1期24-29,共6页World Chinese Journal of Digestology

基　　金：天津市北辰区科技计划项目,No.2018-SHGY-17.

摘　　要：背景门静脉血栓(portal vein thrombosis,PVT)的早期诊断仍是临床上一个难题,急需要发现可早期预测诊断的无创指标.目的探讨门静脉宽度与PVT形成之间的关系.方法收集418例乙肝肝硬化患者.根据是否发生PVT分为PVT组(n=66)和非PVT组(n=352)组.比较两组患者的一般资料差异,使用多因素Logistic回顾分析影响PVT发生的危险因素.通过受试者工作特征(receiver operating characteristic,ROC)曲线评估不同危险因素预测PVT的效能.结果与非PVT组患者相比,PVT组患者的Child-Pugh评分更高、Child-Pugh A级比例更低、血小板水平更高、D-二聚体水平更高、门静脉宽度更宽、门静脉血流更慢,上述差异均存在统计学意义(P<0.05).Logistic回归显示门静脉宽度(OR=3.941,P=0.001)、门静脉血流(OR=0.841,P=0.007)、血小板水平(OR=1.024,P=0.008)和D-二聚体水平(OR=2.383,P=0.000)是肝硬化患者发生PVT的独立危险因素.门静脉宽度诊断PVT的ROC曲线下面积最大为0.874,最佳诊断值为>12.5 mm,此时的预测敏感性和特异性分别为78%和82%.结论门静脉直径增加是肝硬化患者PVT发生的危险因素,对PVT诊断具有一定价值.BACKGROUND The early diagnosis of portal vein thrombosis(PVT)is still a difficult clinical problem.There is an urgent need to find noninvasive indexes that can predict PVT.AIM To investigate the relationship between portal vein width and PVT.METHODS A total of 418 patients with hepatitis B cirrhosis were collected.They were divided into a PVT group(n=66)and a non-PVT group(n=352)according to whether PVT occurred.The general data of the two groups were compared,and the risk factors affecting PVT were analyzed retrospectively by multivariate logistic regression.The effectiveness of different risk factors in predicting PVT was evaluated by receiver operating characteristic(ROC)curve analysis.RESULTS Compared with the non-PVT group,the PVT group had a significantly higher Child-Pugh score,lower rate of Child-Pugh A class,higher platelet count and D-dimer level,wider portal vein width,and slower portal vein blood flow(P<0.05).Logistic regression showed that portal vein width(odds ratio[OR]=3.941,P=0.001),portal vein blood flow(OR=0.841,P=0.007),platelet count(OR=1.024,P=0.008),and D-dimer level(OR=2.383,P=0.000)were independent risk factors for PVT in patients with liver cirrhosis.The maximum area under the ROC curve of portal vein width in the diagnosis of PVT was 0.874,and the best diagnostic threshold was>12.5 mm,with a predictive sensitivity and specificity of 78%and 82%,respectively.CONCLUSION The increase of portal vein diameter is a risk factor for PVT in patients with liver cirrhosis.

关 键 词：乙肝 肝硬化 血栓形成 门静脉 预测诊断 

分 类 号：R575.2[医药卫生—消化系统] R512.62[医药卫生—内科学]