The Clinical Characteristics And Risk Factors Of Portal Vein Thrombosis In 650 Patients With Liver Cirrhosis Portal Vein Thrombosis In 650 Patients

OBJECTIVE: This study retrospectively analyzed the clinical data of 650 cases of liver cirrhosis patient in the First Hospital of Lanzhou University.In this study,the clinical characteristics and risk factors of PVT with cirrhosis were analyzed by comparing the clinical data of patients with portal vein thrombosis and those without portal vein thrombosis.The prediction model was established to provide basis for early detection,diagnosis,prevention and treatment of PVT.METHODS: In this study,a total of 650 hospitalized patients diagnosed cirrhosis admitted to the First Hospital of Lanzhou University from December 2013 to December 2018 were included for retrospective analysis.325 patients with liver cirrhosis complicated with PVT were selected as the experimental group(PVT group),and 325 patients with liver cirrhosis without PVT in the same period were selected as the control group(no PVT group).Studying two groups in the past history,general history,demographic data,laboratory examination,imaging examination and gastroscopy results,clinical manifestation,complications and liver function grade differences aim to find independent risk factors through multi-factor binary logistic regression model.Then establishing the prediction model,and by drawing ROC curve evaluated the model predictive value.RESULTS:1.PVT was a serious complication of liver cirrhosis.The liver cirrhosis Patients combined with PVT have a longer history of hepatitis and liver cirrhosis.BMI value reflected the nutritional status of patients with liver cirrhosis.The patients with liver cirrhosis complicated with PVT whose BMI was obviously reduced,and previous history of splenectomy would increase the risk of PVT formation.Liver cirrhosis complicated with PVT was able to lengthen the hospital time,increase the hospital charge,increase medical treatment burden.2.Liver cirrhosis complicated with PVT seriously affected liver function.Child-pugh score was higher and liver function grade was worse than that without PVT,which would further aggravate portal hypertension,aggravate the degree of ascites and varicose veins,and lead to the frequent occurrence of refractory ascites and gastrointestinal bleeding.The endoscopic manifestations of patients with liver cirrhosis complicated with PVT were mainly esophageal and gastric varicose veins,which were prone to red signs.Previous endoscopic sclerotherapy might increase the risk of PVT formation.In clinical practice,abdominal pain,abdominal distension and fever were more common in patients with PVT,especially the occurrence of intestinal obstruction might be related to the formation of superior mesenteric vein thrombosis.Patients with cirrhosis complicated with PVT were more likely to be complicated with SBP,pulmonary infection,severe hyponatremia,hepatic encephalopathy and hepatorenal syndrome.Symptoms of abdominal pain were more common in the multi-vessel thrombosis group than in the single-vessel thrombosis group,and abdominal pain and intestinal obstruction were more common in PVT patients involving superior mesenteric veins.3.Through multi-factor binary Logistic regression analysis,it was found that the number of gastrointestinal bleeding,d-dimer and portal vein diameter width were independent risk factors related to the formation of PVT.TP,Cr,TT and portal venous blood flow velocity were the protective factors related to the formation of PVT.4.Independent risk factors and protective factors were used to obtain the reg ression equation to predict the risk score of portal vein thrombosis: Logit(P)=11.470+0.460×the number of gastrointestinal bleeding-0.510×TP-0.019×Cr-0.678×TT+0.752×d-dimer+0.437×the portal vein diameter width-0.207×the portal ven ous blood flow velocity.The area under the ROC curve of this prediction mod el was 0.910>0.5(95% CI0.886-0.934,P<0.000),the maximum value of Jordan index was 0.658,the corresponding cut-off point was 0.327,the corresponding sensitivity was 81.9%,specificity was 83.9%,positive likelihood ratio was 5.087,negative likelihood ratio was 0.216.It indicated that this multi-factor predic tion model was of high value for the occurrence of PVT,and its application i n clinical work was of great value,which could bring certain help to the work of clinicians.CONCLUSION:1.Patients with cirrhosis complicated with PVT had worse liver function grading,severe ascites and varicose veins,frequent occurrence of gastrointestinal bleeding.The lack of specificity in clinical manifestations,the Symptoms of abdominal pain,abdominal distension and fever were more common,especially the occurrence of intestinal obstruction might be related to the formation of superior mesenteric vein thrombosis.It was more likely to be complicated with spontaneous peritonitis,electrolyte disturbance,hepatic encephalopathy,hepatorenal syndrome and other serious complications.2.The number of gastrointestinal bleeding,d-dimer and the width of portal vein were independent risk factors related to the formation of PVT.TP,Cr,TT and portal venous blood flow velocity were the protective factors related to the formation of PVT.The prediction model based on these parameters had a good prediction value.