Prevalence and Clinical Significance of Portal Vein Thrombosis in Patients With Cirrhosis and Acute Decompensation
Prevalence and Clinical Significance of Portal Vein Thrombosis in Patients With Cirrhosis and Acute Decompensation
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肝硬化急性失代偿患者门静脉血栓的患病率及临床意义
DOI：
10.1016/j.cgh.2020.02.037
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发表时间：
2020-10-01
影响因子：
12.6
通讯作者：
Hua, Jing
中科院分区：
文献类型：
--
作者：
Zhang, Yan;Xu, Bao-yan;Hua, Jing
背景与目的：门静脉血栓（PVT）是肝硬化患者常见且严重的并发症。然而，对于肝硬化和急性失代偿 (AD) 患者的 PVT 知之甚少。我们调查了非恶性肝硬化和 AD 患者中 PVT 的患病率和临床意义。 方法：我们对 2 组慢性肝病急性加重患者进行了回顾性研究，这些患者参加了由中国慢性肝衰竭联盟建立的中国 AcuTe on CHronic LIver FailurE 研究，时间为 2015 年 1 月至 2016 年 12 月（n = 2600 名患者）和 2018 年 7 月到 2019 年 1 月（n = 1370 名患者）。我们分析了 2826 例伴或不伴 AD 的肝硬化患者的 PVT 患病率、临床表现和危险因素的数据。结果：肝硬化伴 AD 患者的 PVT 患病率为 9.36%，显着高于不伴 AD 的肝硬化患者 (5.24%) (P = .04)。肝硬化合并AD患者中，63.37%近期发生PVT（首次检测到PVT，无慢性PVT指征）。与无PVT的患者相比，PVT患者发生静脉曲张出血的比例显着较高（47.33% vs 19.63%；P < .001），并且PVT患者的中位血清D-二聚体水平显着较高（2.07 vs 1.25；P < .001）。脾切除和内镜下硬化治疗是肝硬化合并AD患者发生PVT的独立危险因素。患有PVT的患者与不患有PVT的患者之间的1年死亡率没有显着差异。结论：在对2826名肝硬化患者的数据进行分析时，患有AD的患者患有PVT的比例明显高于没有AD的患者。 PVT 与静脉曲张出血增加有关，这会增加患 AD 的风险。需要制定策略，通过定期筛查来预防肝硬化患者发生门静脉血栓，从而降低门静脉高压。
BACKGROUND & AIMS: Portal vein thrombosis (PVT) is a common and serious complication in patients with cirrhosis. However, little is known about PVT in patients with cirrhosis and acute decompensation (AD). We investigated the prevalence and clinical significance of PVT in nonmalignant patients with cirrhosis and AD.METHODS: We performed a retrospective study of 2 cohorts of patients with acute exacerbation of chronic liver disease who participated in the Chinese AcuTe on CHronic LIver FailurE study, established by the Chinese Chronic Liver Failure Consortium, from January 2015 through December 2016 (n = 2600 patients) and July 2018 through January 2019 (n =1370 patients). We analyzed data on the prevalence, clinical manifestations, and risk factors of PVT from 2826 patients with cirrhosis, with and without AD.RESULTS: The prevalence of PVT in patients with cirrhosis and AD was 9.36%, which was significantly higher than in patients with cirrhosis without AD (5.24%) (P = .04). Among patients with cirrhosis and AD, 63.37% developed PVT recently (the first detected PVT with no indication of chronic PVT). Compared with patients without PVT, a significantly higher proportion of patients with PVT had variceal bleeding (47.33% vs 19.63%; P < .001) and patients with PVT had a significantly higher median serum level of D-dimer (2.07 vs 1.25; P < .001). Splenectomy and endoscopic sclerotherapy were independent risk factors for PVT in patients with cirrhosis and AD. The 1-year mortality rate did not differ significantly between patients with vs without PVT.CONCLUSIONS: In an analysis of data from 2826 patients with cirrhosis, a significantly higher proportion of those with AD had PVT than those without AD. PVT was associated with increased variceal bleeding, which would increase the risk for AD. Strategies are needed to prevent PVT in patients with cirrhosis, through regular screening, to reduce portal hypertension.