【作者】 张艳；

【导师】 李海；

【作者基本信息】 上海交通大学 ， 内科学（消化系病）， 2020， 硕士

【摘要】 背景与目的:门静脉血栓(portal vein thrombosis,PVT)是肝硬化患者常见的并发症,但是目前缺乏关于PVT在肝硬化急性失代偿(acute decompensation,AD)患者中的研究。我们旨在研究肝硬化AD患者中非肿瘤性PVT的患病率及其临床意义。方法:我们回顾性地研究中国慢(加急)性肝衰竭联盟建立的大型前瞻性、多中性的慢性肝病急性加重患者队列(Chinese AcuTe-on-Chronic Liver FailurE,CATCH-LIFE Study),包括于2015年1月至2016年12月建立的探索队列(n=2600例,NCT编号:NCT02457637)以及于2018年7月至2019年1月建立的验证队列(n=1370例,NCT编号:NCT03641872)。我们基于CATCH-LIFE研究队列中2826例肝硬化住院患者的数据,分析了肝硬化AD患者中非肿瘤性PVT患病率、临床特征和危险因素。结果:在肝硬化AD患者中,PVT患病率为9.36%,显著高于无AD的肝硬化患者(5.24%)(p=0.04)。在肝硬化AD患者中,合并PVT的患者中,有63.37%的PVT是近期形成的。与没有合并PVT的患者相比,合并PVT患者发生食管胃底静脉破裂出血的比例显著增高(47.33%vs 19.63%;p<0.001),血清D-二聚体水平也显著增高(2.07vs1.25;p<0.001)。脾切除术和内镜下硬化剂治疗是肝硬化AD患者发生PVT的独立危险因素。在肝硬化AD患者中,合并或不合并PVT的患者的短期和长期死亡率均无显著差异。结论:在对CATCH-LIFE队列中的2826例肝硬化患者的数据进行分析后,结果发现肝硬化AD患者发生PVT的比例显著高于肝硬化无AD患者。肝硬化患者合并PVT时会促进食管胃底静脉曲张破裂出血,导致AD的发生,从而增加了死亡的风险。应定期筛查PVT并考虑降低门静脉高压,从而预防肝硬化患者PVT的形成。更多还原

【Abstract】 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 nonmalignant PVT in patients with cirrhosis and AD.Methods: Patients came from two prospective multicenter cohorts of patients with acute exacerbation of chronic liver disease,named CATCHLIFE,established by the Chinese Chronic Liver Failure Consortium from January 2015 to December 2016(n=2600,NCT02457637)and July 2018 to January 2019(n=1370,NCT03641872).The prevalence,clinical manifestations and risk factors of PVT in patients with cirrhosis and AD were analyzed.Results: The prevalence of PVT in patients with cirrhosis and AD,was9.36%,significantly higher than those with cirrhosis without AD(5.24%)(p=0.04).Among patients with cirrhosis and AD,PVT mostly occurred recently(63.37%).Compared to patients without PVT,patients with PVT had a significantly higher incidence of variceal bleeding(47.33% vs 19.63%,p<0.001)and a higher serum level of D-dimer(2.07 vs 1.25;p<0.001).Splenectomy and endoscopic sclerotherapy were independent risk factors for PVT in patients with cirrhosis and AD.And among patients with cirrhosis and AD,the short-term and long-term mortality rate did not statistically significant differ between patients with PVT and those without PVT.Conclusions: Patients with cirrhosis and AD had a significant elevated prevalence of PVT.The occurrence of PVT promoted portal hypertension and variceal bleeding,thus would increase the risk for mortality as a result of the development of AD.It would be beneficial to improve portal hypertension through regular screening and preventing PVT in patients with cirrhosis.更多还原