不同分型的肝硬化门静脉血栓的临床特点

目的探讨不同分型的肝硬化门静脉血栓(PVT)的临床特点及差异。方法回顾性分析2016年8月至2019年8月昆明医科大学第二附属医院消化内科收住的肝硬化合并PVT患者107例,依据解剖因素将其分为3组:单纯门静脉主干血栓形成组(主干组,n=17)、单纯分支血栓形成组(分支组,n=35)和门静脉主干并分支血栓形成组(主干+分支组,n=55)。分别从一般临床资料、实验室指标、影像学指标、肝储备及相关评分等方面对不同PVT部位进行比较分析。检验水准取α=0.05,采用分割χ²检验时,校正为α′=0.0125。结果主干+分支组患者更易合并消化道出血,主干组次之,分支组最低,三组间比较差异有统计学意义(χ²=27.832,P<0.01),两两比较示,分支组与主干+分支组、主干组与主干+分支组差异有统计学意义(P<0.0125);主干+分支组D-二聚体水平最高,主干组次之,分支组最低,三组间比较(H=37.439,P<0.01)及两两比较差异均有统计学意义(P<0.05,P<0.01);主干+分支组血浆D-二聚体和纤维蛋白原比值(D/F)最高,主干组次之,分支组最低,三组间比较(H=33.973,P<0.01)及两两比较差异均有统计学意义(P<0.05,P<0.01)。结论血栓累及主干+分支的肝硬化PVT患者,发生消化道出血的风险最高,主干次之,分支最低。D-二聚体、D/F水平的高低可能对不同部位的肝硬化PVT诊断有一定的参考价值。

Clinical characteristics of portal vein thrombosis in different types of cirrhosis

Objective To explore the clinical characteristics and differences of portal vein thrombosis(PVT)in different types of liver cirrhosis.Methods A retrospective analysis was performed on 107 patients with liver cirrhosis complicated with PVT admitted to Department of Gastroenterology of the Second Affiliated Hospital of Kunming Medical University from August 2016 to August 2019.According to the anatomical distribution,they were divided into three groups:simple portal vein thrombosis involved the portal trunk(trunk PVT,n=17)group,simple portal vein branches thrombosis(branch PVT,n=35)group and thrombosis involved the trunk and branches portal vein(trunk and branch PVT,n=55)group.It was analyzed and compared that the associations of the clinical data,laboratory indexes and imaging results,liver reserve parameters and related scores with different types of portal vein thrombosis.For the split chísquare test,the significance levelα=0.05 was used,and the correction level wasα′=0.0125.Results Patients in trunk and branch PVT group were more likely to have gastrointestinal bleeding,followed by trunk PVT group,and the lowest in branch PVT group(χ²=27.832,P<0.01),and there were statistical differences in it by pairwise comparison among the three groups(P<0.0125).D-dimer level was the highest in trunk and branch PVT group,the second in trunk PVT group and the lowest in branch PVT group(H=37.439,P<0.01),and there were statistical differences among three groups by pairwise comparison(P<0.05,P<0.01).D-dimer/fibrinogen ratio(D/F ratio)statistically decreased in the order of trunk and branch PVT group,trunk PVT group and branch PVT group(H=33.973,P<0.01),and there were significant differences among three groups by pairwise comparison(P<0.05,P<0.01).Conclusions The risk of gastrointestinal bleeding is the highest in cirrhotic PVT patients with thrombosis involving trunk and branches,followed by the trunk,and the branches with the lowest risk.DD and D/F may be helpful for the diagnosis of PVT in patients with liver cirrhosis.