肝硬化合并門靜脈血栓的臨床病例回顧性分析
發(fā)布時(shí)間：2018-08-19 15:11
【摘要】：目的:通過搜集分析肝硬化門靜脈血栓住院病人的臨床病例資料,總結(jié)PVT產(chǎn)生的危險(xiǎn)因素并為以后的臨床診治工作提供新的思緒。方法:搜集皖南醫(yī)學(xué)院弋磯山醫(yī)院2014年01月至2016年06月時(shí)期在消化內(nèi)科住院治療的820例肝硬化患者病例資料(排除資料不完整的,共納入研究的病例數(shù)有134例),通過影像學(xué)方法(如彩色多普勒超聲、腹部CT平掃+增強(qiáng)及MRI等)診斷出肝硬化PVT患者。其中肝硬化合并PVT病人有58例,非PVT病人76例。通過對比血栓組(實(shí)驗(yàn)組)與非血栓組(對照組)患者在性別、年齡、手術(shù)史(如脾切除術(shù)后)、腹水、上消化道出血及預(yù)后、血常規(guī)(如紅細(xì)胞、白細(xì)胞、血小板等)、血生化(如白蛋白、AST、ALT等)、血凝常規(guī)(如D-二聚體、PT、APTT、纖維蛋白原等)等臨床特征。采用SPSS19.0軟件進(jìn)行統(tǒng)計(jì)學(xué)的處理,其中計(jì)量資料運(yùn)用T檢驗(yàn),計(jì)數(shù)資料運(yùn)用χ2檢驗(yàn),并采用多因素非條件Logistic回歸分析出肝硬化PVT產(chǎn)生的相關(guān)危險(xiǎn)因素以及對相應(yīng)并發(fā)癥的影響。結(jié)果:134例肝硬化患者中,門靜脈血栓病人58例,男性32例(55%),平均年齡:56.177±14.479歲,女26例(45%),平均年齡69.923±8.664歲;Child評分:A級9例(15.52%)、B級33例(56.90%)、C級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,血吸蟲肝病1例,自身免疫性肝病1例,其他原因不明11例。非門靜脈血栓病人76例,男性39例(51.31%),平均年齡:57.743±15.579歲,女性37例(48.69%)平均年齡:65.972±9.260歲。Child評分:A級43例(56.58%)、B級28例(36.84%)、C級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,血吸蟲肝病2例,自身免疫性肝病4例,其他原因不明23例。主要癥狀有腹痛、乏力納差、腹脹、消化道出血(嘔血及黑便等)、皮膚鞏膜黃染等。肝硬化門靜脈血栓主要發(fā)生在門靜脈主干,占43例(74.13%)。通過肝硬化血栓組和非血栓組的比較,患者在性別和年齡上相似,差異無統(tǒng)計(jì)學(xué)意義(P0.05),在ALP、ALT、GGT、AST、FIB、GLU、PT、ALB、WBC、TG、GLOB、DBIL、CHOL、血K+也相似,差別無統(tǒng)計(jì)學(xué)意義(P0.05),血栓組和非血栓組患者在病因分布、是否合并食管靜脈曲張和肝性腦病上也相似,差別無統(tǒng)計(jì)學(xué)意義(P0.05)。但患者于APTT、FDP、D-二聚體、HB、RBC、PLT、門靜脈主干寬度、血Na+濃度上有統(tǒng)計(jì)學(xué)意義(P0.05),在肝功能分級Child-Pugh評分、是否合并脾臟切除及腹腔積液中存在差別,并有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.肝硬化PVT好發(fā)于門靜脈主干(約占74.13%),其次是門靜脈左右屬支,再次是腸系膜上靜脈、脾靜脈等。診斷主要通過影像學(xué)方法(彩色多普勒超聲、腹部CT及MRI/MRA)進(jìn)行確診。2.肝硬化Child-Pugh評分、門靜脈寬度、脾臟切除后、血漿D-二聚體及FDP是肝硬化PVT形成的主要危險(xiǎn)因素。3.肝硬化PVT合并食管靜脈曲張破裂出血及感染等并發(fā)癥明顯增高,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 鹵14.479 years old, 26 cases (45%) were female, the mean age was 69.923 鹵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 鹵15.579 years old, female 37 cases (48.69%), mean age: 65.972 鹵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.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R575.2
本文編號：2192036
[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 鹵14.479 years old, 26 cases (45%) were female, the mean age was 69.923 鹵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 鹵15.579 years old, female 37 cases (48.69%), mean age: 65.972 鹵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.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R575.2
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