Risk Factors Of Portal Vein Thrombosis In Cirrhosis And Efficacy Analysis Of Anticoagulant Therapy

Objective:(1)To investigate the risk factors and clinical characteristics of portal vein thrombosis in cirrhosis.(2)To investigate the effect of anticoagulation therapy on portal vein thrombosis in cirrhosis.Methods:Collected a total of 80 cases of hospitalized patients in our hospital from June 2016to January 2019,who were diagnosed with liver cirrhosis and under inspection of portal venous trunk and branches with abdominal ultrasound or abdominal enhanced CT or abdominal enhanced MRI,including 40 cases of patients with portal vein thrombosis and others without.They were divided into two groups,one group with portal vein thrombosis and another without.Analyze the general clinical data including age,gender,height,body weight,body mass index(BMI),the smoking history,laboratory indexes including blood routine(WBC,RBC,PLT,Hb),blood coagulation series(FIB,APTT,PT,AT,D-dimer,INR),biochemical(TBIL,ALB,SCr,TG,TC)and other information including Child-Pugh grading,the history of great gastrointestinal bleeding,surgery,diabetes,the esophageal gastric varices sclerotherapy and/or injection of tissue adhesive treatment for esophageal and gastric varices bleeding,meanwhile analyze the related clinical manifestations of the patients such as abdominal pain,abdominal distention,diarrhea,haematemesis,black stool etc.SPSS21.0 software was used for statistical processing,t test was used to calculate measurement data,x~2 test was used to analyze counting data,multivariate logistic regression analysis was used to analyze independent risk factors of liver cirrhosis PVT formation,and P<0.05 was considered as statistical differences.Results:1.Among the 40 patients of liver cirrhosis with PVT,there were 24 males and 16females,with a gender ratio of 1.5:1,ranging from 24 to 83 years old,and an average age of(55.35±6.41)years old.The average BMI was(23.35±4.23)kg/m~2.Among them,Including 13 cases of hepatitis B cirrhosis(32.5%),10 cases of primary biliary cirrhosis(25.0%),2 cases of hepatitis C cirrhosis(5.0%),5 cases of alcoholic cirrhosis(12.5%),and 10 cases of cryptogenic cirrhosis(25.0%).According to Child-Pugh grading,there were 7 patients were grade A(17.5%),24 patients were grade B(60.0%),and 9 patients were grade C(22.5%).Six smokers(15.0%)were male,12 patients(30.0%)were diagnosed with type 2 diabetes,6 patients(15.0%)had previous surgical history,20patients(50.0%)were associated with immune system diseases,and 10.0 patients(25%)had been treated with tissue adhesive and combined with lauromacrogol injection.Among them,32 cases(80.0%)had different degree of ascites,21 cases(52.5%)presented varying degrees of abdominal distension,which were aggravated after eating,13 cases(32.5%)had abdominal pain,15 cases(37.5%)presented with different degree of nausea and vomiting,18 cases(45.0%)presented with hematemesis and black stool,and 1 case of blood transfusion due to massive blood loss;5 cases(12.5%)were characterized by fever,temperature was 37.9~38.0℃;6 cases(15.0%)presented with diarrhea.2.Among the 40 patients of liver cirrhosis without PVT,there were 26 males and 14females,with a male to female ratio of 1.8:1.The age range was(30-78)years,with an average age of(53.89±7.69)years.The average BMI was(21.35±5.28)kg/m~2.Among them,16 cases of hepatitis B cirrhosis(40.0%),8 cases of primary biliary cirrhosis(20.0%),2 cases of hepatitis C cirrhosis(5.0%),1 case of alcoholic cirrhosis(2.0%),and13 cases of cryptogenic cirrhosis(32.5%).According to Child-Pugh grading,there were16 cases of grade A patients(40.0%),20 cases of grade B patients(50.0%),and 4 cases of grade C patients(10.0%).8 smokers(20.0%)were male.8 patients(20.0%)were diagnosed with type 2 diabetes,4 patients(10.0%)had previous surgical history,10patients(25.0%)were associated with immune system diseases,and 1 patient(2.5%)had been treated with tissue adhesive combined with polysiloxane.15 patients(37.5%)had varying degrees of ascites,4 patients(10.0%)presented varying degrees of abdominal distension,2 patients(5.0%)presented abdominal pain,5 patients(12.5%)presented varying degrees of nausea and vomiting,and 12 patients(30.0%)presented varying degrees of hematemesis and black stool.2 cases(5.0%)were characterized by fever,temperature was 37.9~38.0℃,8 cases(20.0%)presented with diarrhea.3.After single factor analysis,two groups of patients in general(gender,age,BMI,smoking history),laboratory indexes(RBC,WBC,Hb,TBIL,TC,SCr,TG,Fn,FDP,ALB,PT,TT and APTT)there was no statistically significant difference(P>0.05),diabetes history,surgical history,liver function grade Child-Pugh score,the difference of upper gastrointestinal bleeding,no statistical significance(P>0.05).However,there were statistically significant differences in PLT,D-dimer,AT,FIB,whether patients were associated with immune system diseases,and history of esophageal and gastric varicose vein sclerotherapy and/or tissue adhesion occlusion(P<0.05).Binary Logistic regression analysis of statistically significant data showed that esophagogastric varicose sclerotherapy and/or tissue adhesion occlusion,PLT,AT,and immune system diseases were statistically significant(P<0.05),with OR values of 13.000,3.298,3.012,and 3.000,respectively.4.Among the 40 patients of liver cirrhosis with portal vein thrombosis,22 patients were treated with anticoagulant therapy,including 18 patients treated with low molecular weight heparin sodium injection or enoxaparin sodium injection in hospital and taken oral warfarin sodium tablets continuously out of hospital,and 4 patients treated with other new anticoagulants like rivaroxaban and dabigatuan.After 6 months of follow-up,6patients showed complete disappearance of portal vein thrombosis in the re-examination of abdominal doppler ultrasound,more than 50%of portal vein recanalization area in 10cases,less than 50%of portal vein recanalization area in 4 cases,1 case died due to massive upper gastrointestinal bleeding,and 1 case died due to liver rupture.The other 18patients did not receive anticoagulation therapy in hospital due to hematemesis,black stool or other unknown reasons.Review after 6 months follow-up by inspection of abdominal ultrasonography,there were 0 case of portal vein thrombosis disappeared completely,2 cases of portal venous recanalization recovery area attained to 50%,2cases of portal venous recanalization recovery area below 50%compared with before,1patient with mesenteric venous thrombosis,4 patients with splenic vein thrombosis.9 of patients with portal venous thrombosis had no obvious change.The total effective rate of anticoagulant therapy in 22 cases of portal thrombosis was 72.7%.Conclusion:(1)PLT count,D-dimer,AT,FIB,combined with immune system diseases,esophagogastric varices sclerotherapy and/or tissue adhesive embolism are risk factors for the formation of PVT in liver cirrhosis;(2)Decreased PLT and AT,concomitant immune system disease,esophagogastric varices sclerotherapy and/or tissue adhesive embolism were independent risk factors for PVT in cirrhosis of the liver.(3)In patients with liver cirrhosis and PVT,if there is no gastrointestinal bleeding symptom and bleeding tendency in other parts,anticoagulant therapy should be given as soon as possible when the condition is stable,which can significantly improve the prognosis and survival of patients.