肝硬化合并门静脉血栓的临床病例回顾性分析

发布时间：2018-08-19 15:11

【摘要】：目的:通过搜集分析肝硬化门静脉血栓住院病人的临床病例资料,总结PVT产生的危险因素并为以后的临床诊治工作提供新的思绪。方法:搜集皖南医学院弋矶山医院2014年01月至2016年06月时期在消化内科住院治疗的820例肝硬化患者病例资料(排除资料不完整的,共纳入研究的病例数有134例),通过影像学方法(如彩色多普勒超声、腹部CT平扫+增强及MRI等)诊断出肝硬化PVT患者。其中肝硬化合并PVT病人有58例,非PVT病人76例。通过对比血栓组(实验组)与非血栓组(对照组)患者在性别、年龄、手术史(如脾切除术后)、腹水、上消化道出血及预后、血常规(如红细胞、白细胞、血小板等)、血生化(如白蛋白、AST、ALT等)、血凝常规(如D-二聚体、PT、APTT、纤维蛋白原等)等临床特征。采用SPSS19.0软件进行统计学的处理,其中计量资料运用T检验,计数资料运用χ2检验,并采用多因素非条件Logistic回归分析出肝硬化PVT产生的相关危险因素以及对相应并发症的影响。结果:134例肝硬化患者中,门静脉血栓病人58例,男性32例(55%),平均年龄:56.177±14.479岁,女26例(45%),平均年龄69.923±8.664岁;Child评分:A级9例(15.52%)、B级33例(56.90%)、C级16例(27.58%);病因分布:乙型病毒性肝炎41例,丙型病毒性肝炎4例,血吸虫肝病1例,自身免疫性肝病1例,其他原因不明11例。非门静脉血栓病人76例,男性39例(51.31%),平均年龄:57.743±15.579岁,女性37例(48.69%)平均年龄:65.972±9.260岁。Child评分:A级43例(56.58%)、B级28例(36.84%)、C级5例(6.58%)病因分布:乙型病毒性肝炎例41例,丙型病毒性肝炎6例,血吸虫肝病2例,自身免疫性肝病4例,其他原因不明23例。主要症状有腹痛、乏力纳差、腹胀、消化道出血(呕血及黑便等)、皮肤巩膜黄染等。肝硬化门静脉血栓主要发生在门静脉主干,占43例(74.13%)。通过肝硬化血栓组和非血栓组的比较,患者在性别和年龄上相似,差异无统计学意义(P0.05),在ALP、ALT、GGT、AST、FIB、GLU、PT、ALB、WBC、TG、GLOB、DBIL、CHOL、血K+也相似,差别无统计学意义(P0.05),血栓组和非血栓组患者在病因分布、是否合并食管静脉曲张和肝性脑病上也相似,差别无统计学意义(P0.05)。但患者于APTT、FDP、D-二聚体、HB、RBC、PLT、门静脉主干宽度、血Na+浓度上有统计学意义(P0.05),在肝功能分级Child-Pugh评分、是否合并脾脏切除及腹腔积液中存在差别,并有统计学意义(P0.05)。结论:1.肝硬化PVT好发于门静脉主干(约占74.13%),其次是门静脉左右属支,再次是肠系膜上静脉、脾静脉等。诊断主要通过影像学方法(彩色多普勒超声、腹部CT及MRI/MRA)进行确诊。2.肝硬化Child-Pugh评分、门静脉宽度、脾脏切除后、血浆D-二聚体及FDP是肝硬化PVT形成的主要危险因素。3.肝硬化PVT合并食管静脉曲张破裂出血及感染等并发症明显增高,是病人死亡的主要原因。
[Abstract]:Objective: to collect and analyze the clinical data of inpatients with portal vein thrombosis of liver cirrhosis, summarize the risk factors of PVT and provide new thoughts for clinical diagnosis and treatment in the future. Methods: from January 2014 to June 2016, 820 patients with cirrhosis of liver were collected from Yaji Mountain Hospital, Southern Anhui Medical College, from January 2014 to June 2016. A total of 134 cases were included in the study. PVT patients with cirrhosis were diagnosed by imaging methods such as color Doppler ultrasound, plain enhanced abdominal CT and MRI. There were 58 cases of cirrhosis with PVT and 76 cases of non-PVT. Sex, age, surgical history (such as after splenectomy), ascites, upper digestive tract hemorrhage and prognosis, blood routine (such as red blood cells, white blood cells) were compared between the thrombus group (experimental group) and non-thrombotic group (control group). Clinical features such as platelet, blood biochemistry (e.g., albumin ASTX alt, etc.), hemagglutination routine (such as D- dimer PTAPTT, fibrinogen, etc.). SPSS19.0 software was used to process statistics, in which T test was used to measure data, 蠂 2 test was used to count data, and multivariate non conditional Logistic regression analysis was used to determine the risk factors of PVT in cirrhosis and its influence on the corresponding complications. Results among the 134 patients with liver cirrhosis, 58 (55%) had portal vein thrombosis, 32 (55%) were male, the average age was 56.177 卤14.479 years old, 26 cases (45%) were female, the mean age was 69.923 卤8.664 years old, 9 cases (15.52%) were in grade A, 33 cases (56.90%) were grade B, 16 cases (27.58%) were grade C, and the etiological distribution was as follows: 41 cases of viral hepatitis B, 45% (45%) of female, 9 cases of grade A (15.52%), 33 cases of grade B (56.90%), and 16 cases of grade C (27.58%). There were 4 cases of viral hepatitis C, 1 case of schistosomiasis liver disease, 1 case of autoimmune liver disease and 11 cases of unknown other causes. There were 76 cases of non-portal vein thrombosis, male 39 cases (51.31%), mean age: 57.743 卤15.579 years old, female 37 cases (48.69%), mean age: 65.972 卤9.260 years old. Child score: 43 cases (56.58%), B grade 28 cases (36.84%), C grade 5 cases (6.58%): hepatitis B 41 cases, hepatitis C 6 cases. There were 2 cases of schistosomiasis liver disease, 4 cases of autoimmune liver disease and 23 cases of other unknown causes. The main symptoms are abdominal pain, anorexia, abdominal distension, gastrointestinal bleeding (hematemesis and black stool), skin scleral yellow staining and so on. Cirrhotic portal vein thrombosis occurred mainly in the main portal vein, accounting for 43 cases (74.13%). There was no significant difference in sex and age between cirrhosis thrombus group and non-thrombus group (P0.05), but there was no significant difference between the two groups (P0.05), and the difference was not statistically significant (P0.05) between the patients with thrombus and non-thrombotic group (P 0.05), and the difference between the two groups was not statistically significant (P0.05), but there was no significant difference in the distribution of blood K between the patients with thrombus and the non-thrombus group (P < 0.05), and the difference between the two groups was not statistically significant (P0.05), but the difference between the two groups was not statistically significant (P0.05). There was no significant difference between esophageal varices and hepatic encephalopathy (P0.05). But there were significant differences in Child-Pugh score of liver function grade, splenectomy and peritoneal effusion in patients with APTTT FDP- D- dimer HBT, portal vein trunk width, blood Na concentration (P0.05). Conclusion 1. Cirrhotic PVT mainly occurred in the main portal vein (74.13%), followed by the left and right branches of portal vein, and then the superior mesenteric vein and splenic vein. The diagnosis was mainly made by imaging methods (color Doppler ultrasound, abdominal CT and MRI/MRA). Child-Pugh score, portal vein width, splenectomy, plasma D-dimer and FDP were the main risk factors of PVT formation in cirrhosis. PVT with esophageal varices bleeding and infection increased significantly, which was the main cause of death.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2

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