肝硬化并发门静脉系统血栓形成风险和特征分析及列线图模型构建  

Analysis of risk factors and characteristics and establishment of nomogram model for liver cirrhosis complicated with portal venous system thrombosis

作　　者：王琰 余保平[1] Wang Yan;Yu Baoping(Department of Gastroenterology,Renmin Hospital of Wuhan University,Wuhan 430000,China)

机构地区：[1]武汉大学人民医院消化内科,湖北武汉430000

出　　处：《临床内科杂志》2024年第9期601-605,共5页Journal of Clinical Internal Medicine

摘　　要：目的 探讨肝硬化患者门静脉系统血栓形成(PVST)的危险因素和特征并进行列线图模型的构建及验证。方法 根据是否合并PVST将388例肝硬化患者分为血栓组(142例)与非血栓组(246例),再根据血栓类型将血栓组分为主干组(27例)、分支组(36例)和混合组(79例),比较各组患者一般临床资料及实验室检查结果。采用多因素logistic回归分析评估肝硬化患者PVST的危险因素并构建列线图预测模型,对模型的准确性进行内部验证。采用校准曲线和受试者工作特征(ROC)曲线评价模型的预测效果。结果 血栓组Hb、纤维蛋白原(FIB)均显著低于非血栓组,而D-二聚体(D-D)、门静脉主干(MPV)宽度、腹腔积液、消化道出血、脾脏切除史、内镜治疗史、Child-Pugh分级为B/C级患者病例均显著高于非血栓组(P<0.05)。主干组脾切除史占比高于分支组,白蛋白(Alb)低于分支组;主干组PT活动度(PTA)、Alb高于混合组,凝血酶原时间(PT)、国际正常化比值(INR)、D-D及腹腔积液占比均低于混合组;分支组PTA、Alb均高于混合组,PT、INR、D-D、MPV宽度及腹腔积液、消化道出血、脾脏切除史、内镜治疗史、Child-Pugh分级为B/C级患者比例均低于混合组(P<0.05)。多因素logistic回归分析结果显示,D-D、MPV宽度、脾脏切除史、内镜下治疗史均为肝硬化患者PVST的独立危险因素(P<0.05)。基于以上独立危险因素建立列线图预测模型,一致性指数为0.801,提示预测模型校准度良好。结论 D-D、MPV宽度、脾脏切除史和内镜下治疗史均为肝硬化患者并发PVST的独立危险因素,PVST患者中混合型血栓并发症更多,肝功能及凝血功能表现更差。根据以上因素建立的列线图预测模型,可对肝硬化患者PVST风险进行预测。Objective To investigate the risk factors and characteristics of portal venous system thrombosis(PVST) in patients with liver cirrhosis and to construct and verify a nomogram model.MethodsThe 388 cirrhotic patients were divided into thrombus group(142 cases) and non-thrombus group(246 cases) according to whether they were combined with PVST or not,and then the thrombus group was divided into main group(27 cases),branch group(36 cases) and mixed group(79 cases) according to the type of thrombus,and the general clinical data and laboratory examination results of patients in each group were compared.Multifactorial logistic regression analysis was used to assess the risk factors for PVST in cirrhotic patients and construct a nomogram model,and the accuracy of the model was internally validated.Calibration curves and subject work characteristics(ROC) curves were used to evaluate the predictive effect of the model.Results Hb and fibrinogen(FIB) were significantly lower in the thrombus group than in the non-thrombus group,whereas patients with D-dimer(D-D),main portal vein(MPV) width,peritoneal effusion,gastrointestinal bleeding,history of splenectomy,history of endoscopic treatment,and Child-Pugh grade B/C cases were significantly higher than those in the non-thrombotic group(P<0.05).The percentage of history of splenectomy was higher in the main group than in the branch group,and albumin(Alb) was lower than in the branch group;PT activity(PTA) and Alb were higher in the main group than in the mixed group,and the percentage of prothrombin time(PT),international normalised ratio(INR),D-D,and peritoneal effusion were lower than in the mixed group;PTA and Alb were higher in the branch group than in the mixed group,and PT,INR,D-D,MPV width and the proportion of patients with abdominal fluid,gastrointestinal bleeding,history of splenectomy,history of endoscopic treatment,and Child-Pugh grade of B/C were lower than that of the mixed group(P<0.05).The results of multifactorial logistic regression analysis showed that D-D,MPV

关 键 词：肝硬化 门静脉系统血栓形成 危险因素 列线图 

分 类 号：R572[医药卫生—消化系统]