Non-surgical porto-mesenteric vein thrombosis is associated with worse long-term outcomes in inflammatory bowel diseases  

非手术相关的门静脉/肠系膜静脉血栓形成可致炎性肠病患者长期结局不良

作　　者：Zubin Arora Xianrui Wu Udayakumar Navaneethan Bo Shen 

机构地区：[1]Department of Internal Medicine,The Cleveland Clinic Foundation,Cleveland,OH,USA [2]Department of Gastroenterology and Hepatology,The Cleveland Clinic Foundation,Cleveland OH,USA

出　　处：《Gastroenterology Report》2016年第3期210-215,I0002,共7页胃肠病学报道（英文）

基　　金：The research and education activity of Bo Shen,MD,is supported by the Ed and Joey Story Endowed Chair.The remaining authors declare no funding support.

摘　　要：Objective:Our aim was to assess the risk factors for non-surgery-related portal and mesenteric vein thrombosis(PMVT)and its impact on the outcomes of inflammatory bowel diseases(IBD).Methods:All patients with a concurrent diagnosis of IBD and PMVT between January 2004 and October 2013 were identified from the electronic medical record(study group;n=20).Patients were matched for age,sex,and IBD phenotype with control IBD patients who had no PMVT,with a ratio of 1:3(control group;n=60).Risk factors for PMVT and IBD-related outcomes at one year after diagnosis of PMVT were compared between the two groups.Results:Of the 20 patients in the Study group,6(30%)had UC,14(70%)had CD and 11(55%)were male.On multivariable analysis,inpatient status(odds ratio[OR]6.88;95%confidence interval[CI]1.88-25.12)and baseline corticosteroid use(OR 4.39;95%CI 1.27-15.19)were found to be independent risk factors for the development of PMVT.At one-year follow-up,PMVT patients were more likely to have an adverse outcome of IBD,including subsequent emergency room visit(26.3%vs.1.7%;P=0.003),hospitalization for medical management(60.0%vs.20.0%;P=0.001)or IBD-related surgery(65.0%vs.26.7%;P=0.003)than the non-PMVT controls.In multivariable analysis,PMVT(OR 5.19;95%CI 1.07-25.28)and inpatient status(OR 8.92;95%CI 1.33-59.84)were found to be independent risk factors for poor outcome,whereas baseline immunomodulator use(OR 0.07;95%CI 0.01-0.51)was found to be a protective factor.Conclusions:IBD patients who were inpatients or receiving corticosteroid therapy had an increased risk of the development of PMVT.The presence of PMVT was associated with poor clinical outcomes in IBD.目的:本研究旨在评估炎性肠病(IBD)患者出现非手术相关的门静脉/肠系膜静脉血栓形成(PMVT)的危险因素及其对患者长期结局的影响。方法:通过电子医疗记录纳入2004-2013年间20例IBD合并PMVT患者(研究组)。根据年龄、性别及IBD分型进行1:3匹配,筛选出60例未合并PMVT的IBD患者(对照组)。分析PMVT的危险因素,并比较PMVT诊断后1年两组患者IBD相关结局。结果:研究组20例患者中溃疡性结肠炎6例(30%),克罗恩病14例(70%),其中11例(55%)为男性。多因素分析显示,住院治疗(OR=6.88;95%CI:1.88-25.12)和甾体类药物使用(OR=4.39;95%CI:1.27-15.19)是PMVT形成的独立危险因素。随访1年,PMVT患者IBD相关结局较非PMVT患者更差,包括后续的急诊看病率(26.3%vs.1.7%;P=0.003),入院治疗率(60.0%vs.20.0%;P=0.001),IBD相关手术率(65.0%vs.26.7%;P=0.003)。多因素分析显示,PMVT(OR=5.19;95%CI:1.078-25.28)和住院治疗(OR=8.92;95%CI:1.33-59.84)是预后不良的独立危险因素,而免疫抑制剂的使用则是一项保护因素(OR=0.07;95%CI:0.01-0.51)。结论:住院治疗或接受甾体类药物治疗的IBD患者出现PMVT的风险增高。PMVT的发生可导IBD患者临床结局不良。

关 键 词：inflammatory bowel diseases portal vein thrombosis OUTCOMES risk factors 

分 类 号：R57[医药卫生—消化系统]