急性胰腺炎静脉血栓形成的影响因素分析  

Analysis of risk factors for venous thrombosis in acute pancreatitis

作　　者：尚海涛[1] 马少军[2] 张西波[1] Shang Haitao;Ma Shaojun;Zhang Xibo(Department of Hepatobiliary Pancreatic Surgery,Tianjin Nankai Hospital/Tianjin Integrated Traditional Chinese and Western Medicine Hospital,Tianjin 300100,China;Department of Vascular Surgery,Tianjin Nankai Hospital/Tianjin Integrated Traditional Chinese and Western Medicine Hospital,Tianjin 300100,China)

机构地区：[1]天津市南开医院/天津市中西医结合医院肝胆胰外科,天津300100 [2]天津市南开医院/天津市中西医结合医院血管外科,天津300100

出　　处：《血管与腔内血管外科杂志》2024年第6期739-743,共5页Journal of Vascular and Endovascular Surgery

摘　　要：目的分析急性胰腺炎(AP)患者门静脉和脾静脉血栓形成的影响因素。方法收集2018年2月至2023年3月天津市南开医院/天津市中西医结合医院收治的309例AP患者的临床资料,全部患者治疗后随访3个月,将发生了门静脉和脾静脉血栓的患者作为血栓组(n=103),根据血栓组患者的性别、年龄采用倾向匹配法按1:2的比例选取未发生静脉血栓的患者作为非血栓组(n=206)。比较两组患者的一般资料、入院后48 h内化验指标[凝血酶原时间(PT)、血小板计数(PLT)、C反应蛋白(CRP)、D-二聚体(D-D)、中性粒细胞百分比(NEUT)]及相关病史。分析AP并发静脉血栓的影响因素,并通过受试者工作特征(ROC)曲线及其曲线下面积(AUC)评估各影响因素单独及联合应用对AP并发静脉血栓的诊断效能。结果单因素分析结果显示,血栓组患者的PT短于非血栓组患者,CRP水平、D-D水平、NEUT及有食管胃底静脉曲张病史的比例均高于非血栓组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,CRP水平较高、D-D水平较高、NEUT较高及有食管胃底静脉曲张病史均为AP并发静脉血栓的危险因素(P﹤0.05);PT较慢为AP并发静脉血栓的保护因素(P﹤0.05)。ROC曲线分析结果显示,CRP≥19.785 mg/L、NEUT≥10.485×109/L、D-D≥511.800μg/L、有食管胃底静脉曲张病史、PT﹤11.395 s可提示AP并发静脉血栓的可能性(P﹤0.05);CRP、NEUT对AP并发静脉血栓具有中等预测价值,D-D、有食管胃底静脉曲张病史、PT对AP并发静脉血栓具有较低的预测价值,各影响因素联合应用对AP并发静脉血栓的预测价值较高(P﹤0.05)。结论CRP水平、D-D水平、NEUT较高及有食管胃底静脉曲张史均为AP并发静脉血栓的危险因素,PT较慢为AP并发静脉血栓的保护因素。针对以上影响因素完善AP患者的相关检查,开展专项防治,是提高门静脉与脾静脉血栓形成防治水平的重要基础。Objective To analyze the risk factors of portal vein and splenic venous thrombosis in patients with acute pancreatitis(AP).Method The Clinical data of 309 patients with AP admitted to Tianjin Nankai Hospital/Tianjin Integrated Traditional Chinese and Western Medicine Hospital from February 2018 to March 2023 were collected.All patients were followed up for 3 months after treatment,and patients with portal vein and splenic venous thrombosis were included in the thrombosis group(n=103).According to the gender and age of the thrombosis group patients,a propensity matching method was used to select 206 patients with AP who did not develop venous thrombosis in a 1∶2 ratio and were included in the nonthrombosis group(n=206).The general information,laboratory indicators within 48 hours after admission[prothrombin time(PT),platelet count(PLT),C-reactive protein(CRP),D-dimer(D-D),neutrophil percentage(NEUT)],and related medical history of two groups of patients were compared.The influencing factors of AP complicated with venous thrombosis was analyzed,and the diagnostic efficacy of individual and combined application of each influencing factor on AP complicated with venous thrombosis through the receiver operator characteristic(ROC)curve and its area under the curve(AUC)were evaluated.Result The results of univariate analysis showed that the PT of thrombosis group patients was shorter than that of non-thrombosis group patients,the levels of CRP,D-D,NEUT,and the proportion of patients with a history of esophageal and gastric varices were higher than those of non-thrombosis group patients,the differences were statistically significant(P<0.05).The results of multivariate analysis showed that higher CRP level,higher D-D level,higher NEUT,and a history of esophageal and gastric varices were all risk factors for AP complicated with venous thrombosis(P<0.05);slower PT is a protective factor for AP complicated with venous thrombosis(P<0.05).ROC curve analysis results showed,CRP≥19.785 mg/L,NEUT≥10.485×109/L,D-D≥511.800μ

关 键 词：急性胰腺炎 门静脉血栓 脾静脉血栓 危险因素 

分 类 号：R543[医药卫生—心血管疾病]