肝硬化并发门静脉血栓的危险因素及中医证候特点

目的探讨肝硬化门静脉血栓(PVT)发生的危险因素及中医证候特点。方法选取2015年1月-2019年3月在上海中医药大学附属曙光医院住院的并发PVT的肝硬化患者62例,同时随机抽取66例无PVT肝硬化患者作为对照。收集并比较两组患者的临床资料。计量资料组间比较采用独立样本t检验或Mann-WhitneyU秩和检验,计数资料组间比较采用χ2检验或Fisher精确概率法,多因素分析采用非条件多因素logistic回归。结果单因素分析结果显示,PVT组与无PVT组患者在肝硬化病因(χ2=12.902,P=0.036)、ALT(Z=-2.571,P=0.010)、AST(Z=-2.801,P=0.005)、胆碱酯酶(t=-2.579,P=0.011)、纤维蛋白降解产物(Z=-4.410,P<0.001)、D-二聚体(Z=-4.888,P<0.001)、中性粒细胞百分比(Z=-3.124,P=0.002)、门静脉主干内径(t=2.572,P=0.012)、门静脉血流速度(t=-2.441,P=0.016)、脾静脉内径(t=3.175,P=0.002)、脾脏厚径(t=4.575,P<0.001)、脾脏长径(Z=-4.028,P<0.001)和腹腔积液量(t=2.273,P=0.025)等方面差异均有统计学意义;进一步logistic回归分析结果显示,D-二聚体(比值比为2.078,95%置信区间(95%CI):1.293~3.339,P=0.003)、脾脏长径(比值比为1.964,95%CI1.228~3.142,P=0.005)是肝硬化并发PVT的独立危险因素;乏力(100%)、脾大(74.19%)、腹胀(46.77%)、食管胃静脉曲张重度(48.29%)、静脉曲张出血史(40.32%)、舌淡红(43.55%)、脉弦/细(96.77%)是肝硬化并发PVT患者的主要特征。结论D-二聚体水平升高、脾脏长径长是肝硬化并发PVT的独立危险因素,其证候特点符合气虚血瘀证表现。

TCM syndrome characteristics of portal vein thrombosis in patients with liver cirrhosis and related risk factors

Objective To investigate the traditional Chinese medicine (TCM) syndrome characteristics of portal vein thrombosis (PVT) in patients with liver cirrhosis and related risk factors.Methods A total of 62 patients with liver cirrhosis and PVT who were hospitalized in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2015 to March 2019 were enrolled as PVT group,and 66 liver cirrhosis patients without PVT were enrolled as non-PVT group.Related clinical data were compared between the two groups.The independent samples t -test or the Mann-Whitney U test was used for comparison of continuous data between groups,the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups,and the unconditional multivariate logistic regression was used for multivariate analysis.Results The univariate analysis showed that there were significant differences between the PVT group and the non-PVT group in the etiology of liver cirrhosis (χ 2=12.902,P =0.036),alanine aminotransferase ( Z=-2.571,P =0.010),aspartate aminotransferase ( Z=-2.801,P =0.005),cholinesterase (t=-2.579,P =0.011),fibrinogen degradation product ( Z=-4.410,P <0.001),D-dimer ( Z=-4.888,P <0.001),percentage of neutrophils (Z=-3.124,P =0.002),internal diameter of the main portal vein (t=2.572,P =0.012),blood flow velocity of the portal vein (t=-2.441,P =0.016),diameter of the splenic vein (t=3.175,P =0.002),spleen thickness (t=4.575,P <0.001),spleen length ( Z=-4.028,P <0.001),and volume of peritoneal effusion ( t=2.273,P =0.025).The logistic regression analysis showed that D-dimer (odds ratio OR]=2.078,95% confidence interval CI]: 1.293-3.339,P =0.003) and spleen length (OR=1.964,95%CI: 1.228-3.142,P =0.005) were independent risk factors for PVT in patients with liver cirrhosis.Fatigue (100%),splenomegaly (74.19%),abdominal distension (46.77%),severe esophagogastric varices (48.29%),history of variceal bleeding (40.32%),light-reddish tongue (43.55%),and stringy/thready pulse (96.77%) were the main characteristics of patients with liver cirrhosis and PVT,which were consistent with the manifestations of Qi deficiency and blood stasis syndrome.Conclusion An increase in D-dimer level and a long spleen length are independent risk factors for PVT in patients with liver cirrhosis,and the syndrome characteristics of such patients are consistent with the manifestations of Qi deficiency and blood stasis syndrome.