肝硬化门静脉血栓形成机制研究进展  

Advances in Mechanisms of Portal Vein Thrombosis in Liver Cirrhosis

作　　者：武雅荣 张永强 郑英[2] 王彩红 WU Yarong;ZHANG Yongqiang;ZHENG Ying;WANG Caihong(The First Clinical Medical College of Gansu University of Chinese Medicine,Lanzhou 730000,China;Department of Gastroenterology,The 940th Hospital of PLA Joint Logistic Support Force,Lanzhou 730050,China)

机构地区：[1]甘肃中医药大学第一临床医学院,兰州730000 [2]中国人民解放军联勤保障部队第940医院消化内科,兰州730050

出　　处：《协和医学杂志》2025年第2期439-447,共9页Medical Journal of Peking Union Medical College Hospital

基　　金：甘肃省卫生行业科研计划项目(GSWSKY2023-303);兰州市科技计划项目(2023-4-1);联勤保障部队第九四〇医院G计划类项目(2024-G2-4)。

摘　　要：门静脉血栓(portal vein thrombosis,PVT)是肝硬化最常见的并发症之一,其形成可增高肝硬化患者病死率,影响肝移植的顺利实施和预后。高凝状态是肝硬化患者PVT形成的特殊机制。近年来,PVT的发病机制逐渐明晰,具体机制包括以下几个方面:系统性和局部炎症反应导致血管内皮细胞功能损伤,从而促进凝血系统活化;单核巨噬细胞系统异常活化加剧局部炎症,从而增强血小板粘附和聚集,促进血栓形成;凝血与纤溶系统失衡导致机体持续高凝状态;肠道菌群失调导致炎症和代谢紊乱,从而增高PVT发生风险。本文对上述关键机制及其相互作用的最新研究进展进行总结,以期为深入揭示PVT的分子与细胞机制提供新视角,同时为未来PVT的早期诊断和探索新型干预策略指明方向。Portal vein thrombosis(PVT)is one of the most common complications of liver cirrhosis.The formation of PVT can increase the mortality rate of cirrhotic patients and adversely affect the successful implementation and prognosis of liver transplantation.A hypercoagulable state is a unique mechanism underly⁃ing PVT formation in cirrhotic patients.In recent years,the pathogenesis of PVT has gradually been elucida⁃ted,with specific mechanisms including the following aspects:systemic and local inflammatory responses lead to vascular endothelial cell dysfunction,thereby promoting the activation of the coagulation system;abnormal activation of the monocyte⁃macrophage system exacerbates local inflammation,enhancing platelet adhesion and aggregation,and facilitating thrombus formation;an imbalance between the coagulation and fibrinolytic systems results in a sustained hypercoagulable state;and intestinal microbiota dysbiosis induces inflammation and metabolic disturbances,thereby increasing the risk of PVT.This article summarizes the latest research progress on these key mechanisms and their interactions,providing new insights into the molecular and cellular mechanisms of PVT.It also offers directions for the early diagnosis of PVT and the exploration of novel interven⁃tion strategies in the future.

关 键 词：肝硬化 门静脉血栓 炎症反应 凝血系统 纤溶系统 血管内皮细胞 肠道菌群 

分 类 号：R363[医药卫生—病理学] R575.2[医药卫生—基础医学]