AJG：肝硬化门静脉血栓形成预测因素

    近日，日本学者Hitoshi Maruyama发表论文，旨在调查肝硬化患者新发性门静脉血栓形成（PVT）的预测因素和长期转归。研究指出，侧支血管的发展是病毒性肝硬化患者发生PVT的一个重要预测因素。自发性消退或外观不变是血栓形成的最常见转归，对预后影响不大。该文在线发表于《美国胃肠病学杂志》。
　　检测150例病毒性肝硬化的PVT（通过多普勒超声诊断）发病率和预测因素以及预后，无PVT患者为基线。
　　28%的患者发展为PVT（42/150），1、5、8-10年的累积发生率分别为12.8%、20%和38.7%。基线最大侧支血管流量是血栓形成的一个独立危险因素（危险比：3.922；95%可信区间，3.697-4.415；P＜0.0001）。最大侧支血管流速＞10 cm/s的PVT患者1、5、10年累计发生率（19.1%，27%和78.4%）与最大侧支血管流速≤10 cm/s患者相比（8.6%，16.3%和24.7%）明显增高（P＝0.0303）；最大侧支血管流量＞400 ml/min的PVT患者1、5、10年累计发生率（27.4%，36.5%和74.6%）与流量≤400 ml/min的患者相比（10.6%，16.2%和28.8%）明显增高（P＝0.0075）。血栓形成的自然进程47.6%好转，45.2%没有改变，7.2%恶化。改进的患者与其他患者相比，血栓检测最大侧支血管的直径和流量明显减小。血栓形成组和非血栓形成组累积生存率相似。
与肝硬化相关的拓展阅读：

• Hepatology：丙肝肝硬化大多因酗酒导致
• J Hepatol：肝硬化患者骨折风险增高
• GUT：急性肾损害或将影响肝硬化腹水患者的预后
• GUT：轻度急性肾损害会影响肝硬化腹水患者的预后
• Lancet：长期替诺福韦酯治疗可逆转慢乙肝肝硬化
• J HEPATOL：博赛泼维药物组合治晚期纤维化/肝硬化安全有效
更多信息请点击：有关肝硬化更多资讯

De novo Portal Vein Thrombosis in Virus-Related Cirrhosis: Predictive Factors and Long-Term Outcomes.
OBJECTIVES
The objective of this study is to investigate predictive factors and long-term outcomes of de novo portal vein thrombosis (PVT) in cirrhosis.
METHODS
The incidence and factors predictive of PVT (diagnosed by Doppler ultrasound) and prognosis were examined in 150 patients with virus-related cirrhosis but without PVT at baseline.
RESULTS
PVT developed in 28% of patients (42/150), with cumulative incidence of 12.8%, 20%, and 38.7% at 1, 5, and 8-10 years, respectively. The baseline flow volume in the largest collateral vessel was an independent risk factor for thrombosis (hazard ratio, 3.922; 95% confidence intervals, 3.697-4.415; P<0.0001). The cumulative incidence of PVT at 1, 5, and 10 years was significantly higher in patients with the largest collateral vessel velocity >10 cm/s (19.1%, 27%, and 78.4%, respectively) compared with those with velocity ≤10 cm/s (8.6%, 16.3%, and 24.7%, respectively, P=0.0303), and higher in patients with volume >400 ml/min (27.4%, 36.5%, and 74.6%, respectively) compared with those with volume ≤400 ml/min (10.6%, 16.2%, and 28.8%, respectively, P=0.0075). The natural course of thrombosis was improvement in 47.6%, unchanged in 45.2%, and worsened in 7.2%. The diameter and flow volume in the largest collateral vessel at the time of thrombus detection were significantly smaller in the improved patients than the others. The cumulative survival rate was similar between the thrombosis group and non-thrombosis group.
CONCLUSIONS
Development of collateral vessels was a significant predictive factor for the occurrence of PVT in virus-induced cirrhosis. Spontaneous resolution or unchanged appearance was the most common outcome of thrombosis, which had little influence on prognosis.