目标:在肝硬化患者中,门静脉血栓(PVT)是常见的,但通常无症状和偶然发现。该研究旨在调查近期发生胃食管静脉曲张破裂出血(GVH)的肝硬化患者中晚期PVT的患病率和临床特征。
方法:肝硬化患者,他最近患有GVH,并接受进一步治疗以防止静脉曲张再出血,是回顾性招募的。肝静脉压力梯度(HVPG)测量,门静脉的对比增强计算机断层扫描(CT)检查,进行内镜检查。PVT通过CT检查诊断为轻度或晚期。
结果:共纳入356例患者,其中80人(22.5%)患有晚期PVT。与轻度和无PVT的患者相比,晚期PVT患者的白细胞计数和血清D-二聚体水平更高。在那些拥有高级PVT的人中,HVPG较低,该值超过12mmHg的患者较少,但III级食管静脉曲张和有红色征象的静脉曲张均更为普遍.在多变量分析中,白细胞计数(OR=1.401,95%CI,1.171-1.676,P<0.001),D-二聚体水平(OR=1.228,95CI,1.117-1.361,P<0.001),HVPG(OR=0.942,95%CI,0.900-0.987,P=0.011),和III级食管静脉曲张(OR=4.243,95%CI,1.420-12.684,P=0.010)与晚期PVT相关。
结论:高级PVT,这与更严重的高凝状态和炎症状态有关,在GVH肝硬化患者中导致严重的肝前门脉高压。本文受版权保护。保留所有权利。
OBJECTIVE: Portal venous thrombosis (PVT) in cirrhotic patients is usually asymptomatic and diagnosed incidentally. In this study we aimed to investigate the prevalence and characteristics of advanced PVT in cirrhotic patients with a recent episode of gastroesophageal variceal hemorrhage (GVH).
METHODS: Cirrhotic patients with recent GVH at one month before their admission for further treatment to prevent rebleeding were retrospectively recruited. Hepatic venous pressure gradient (HVPG) measurements, contrast-enhanced computed tomography (CT) scan of the portal vein system, and endoscopy were performed. PVT was diagnosed by CT examination and classified as none, mild and advanced.
RESULTS: Of the 356 patients enrolled, 80 (22.5%) had advanced PVT. Elevated levels of white blood cells (WBC) and serum D-dimer were observed in advanced PVT patients compared with those with no or mild PVT. Moreover, HVPG was lower in patients with advanced PVT, with fewer patients having HVPG exceeding 12 mmHg, while grade III esophageal varices and varices with red signs were more prevalent. Multivariate analysis showed that WBC count (odds ratio [OR] 1.401, 95% confidence interval [CI] 1.171-1.676, P < 0.001), D-dimer level (OR 1.228, 95% CI 1.117-1.361, P < 0.001), HVPG (OR 0.942, 95% CI 0.900-0.987, P = 0.011), and grade III esophageal varices (OR 4.243, 95% CI 1.420-12.684, P = 0.010) were associated with advanced PVT.
CONCLUSIONS: Advanced PVT, which is associated with a more severe hypercoagulable and inflammatory status, causes severe prehepatic portal hypertension in cirrhotic patients with GVH.