肝硬化门静脉血栓与非选择性β受体阻滞剂的关系及其危险因素探讨  

Relationship between portal vein thrombosis in liver cirrhosis and non-selective β receptor blockers and its risk factors

作　　者：陈佳[1] 肖潇[1] 万晓强 郑伟[2] Chen Jia;Xiao Xiao;Wan Xiaoqiang;Zheng Wei(Department of Gastroenterology,Chongqing Fourth People's Hospital/Central Hospital Affiliated to Chongqing University,Chongqing 400010,China;不详)

机构地区：[1]重庆市第四人民医院/重庆大学附属中心医院消化内科,400010 [2]重庆市第四人民医院/重庆大学附属中心医院影像科,400010

出　　处：《疑难病杂志》2023年第1期73-77,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：重庆市科卫联合医学科研项目面上项目(2021MSXM031);重庆市渝中区科委基础研究与前沿探索项目(20180148)。

摘　　要：目的 分析肝硬化门静脉血栓(PVT)与非选择性β受体阻滞剂(NSBB)的关系,并了解PVT形成的危险因素及预后情况。方法 收集2016年7月—2019年10月于重庆大学附属中心医院首次诊断PVT的肝硬化患者84例作为PVT组,并选取同期肝硬化不伴PVT的患者90例作为对照组,统计2组住院前、后服用NSBB的情况,比较2组临床资料及预后情况,采用多因素Logistic回归分析PVT形成的危险因素。结果 2组住院前使用NSBB差异无统计学意义(P>0.05),但住院后PVT组使用NSBB比例高于对照组(χ^(2)/P=4.372/0.037)。PVT组患者有腹部手术史、脾切除术及既往内镜治疗比例高于对照组(χ^(2)/P=5.224/0.022、17.154/<0.001、7.992/0.005),血红蛋白水平低于对照组(t/P=3.360/0.001)。多因素Logistic回归分析结果显示,脾切除术、既往内镜治疗是PVT形成的独立危险因素[OR(95%CI)=12.483(2.819~55.284)、2.753(1.319~5.747)],血红蛋白高是其保护因素[OR(95%CI)=0.985(0.975~0.995)]。PVT组发生腹水、消化道出血比例高于对照组(χ^(2)/P=10.618/0.001、21.965/<0.001),但2组病死率比较差异无统计学意义(P>0.05)。结论 使用NSBB是肝硬化进展、门静脉压力增高所致的结果,而非PVT形成的原因。脾切除术、既往内镜治疗、血红蛋白低是PVT形成的高危因素,PVT可增加患者腹水及消化道出血的发生风险。Objective To analyze the relationship between portal vein thrombosis(PVT) in liver cirrhosis and non-selective β receptor blockers(NSBB) and the risk factors of PVT formation and prognosis. Methods From July 2016 to October 2019, 84 patients with liver cirrhosis who first diagnosed PVT in the Affiliated Central Hospital of Chongqing University were collected as the PVT group, and 90 patients with liver cirrhosis without PVT in the same period were selected as the control group. Statistics were made on the use of NSBB before and after hospitalization in the two groups, and the clinical data and prognosis of the two groups were compared. Multifactor Logistic regression was used to analyze the risk factors of PVT formation. Results There was no significant difference in the use of NSBB between the two groups before hospitalization(P>0.05), but the use of NSBB in PVT group was higher than that in the control group after hospitalization(χ^(2)/P=4.372/0.037). The proportion of patients with abdominal surgery history, splenectomy and previous endoscopic treatment in PVT group was higher than that in control group(χ^(2)/P=5.224/0.022, 17.154/< 0.001, 7.992/0.005), and the hemoglobin level was lower than that of the control group(t/P=3.360/0.001). Multivariate logistic regression analysis showed that splenectomy and previous endoscopic treatment were independent risk factors for PVT formation [OR(95% CI)=12.483(2.819-55.284), 2.753(1.319-5.747)], and high hemoglobin was a protective factor [OR(95% CI)=0.985(0.975-0.995)]. The proportion of ascites and gastrointestinal bleeding in PVT group was higher than that in control group(χ^(2)/P=10.618/0.001, 21.965/<0.001), but there was no significant difference in mortality between the two groups(P>0.05). Conclusion The use of NSBB is the result of the progress of liver cirrhosis and the increase of portal vein pressure, not the cause of PVT. Splenectomy, previous endoscopic treatment and low hemoglobin are high risk factors for PVT. PVT can increase the risk of ascites and g

关 键 词：肝硬化 门静脉血栓 非选择性Β受体阻滞剂 危险因素 

分 类 号：R657.31[医药卫生—外科学]