Analysis Of Risk Factors For Portal Vein Thrombosis In Cirrhosis Patients

Object To study the risk factors of portal vein thrombosis in cirrhosispaitients andtheir effect on complications and survival timeMethod Review294cases of cirrhosis patients diagnosed in our hospital from2009.1~2011.12. Multislices spiral computed tomography or color doppler ultrasound wereused to diagnose PVT. The patients were divided into two groups:55cases withthrombus vs239cases without thrombus. The patients’ age,sex, pathogeny of cirrhosis,complications(ascites, esophageal varices, upper gastrointestinal bleeding, state ofhepatic encephalopathy, etc)were recorded and analyzed. Main portal vein internaldiameter, portal vein velocity,spleen thickness and ascites fluid were measured by colordoppler ultrasound。Esophageal varices was checked by gastroscope and laboratoryexaminations were conducted: including blood routine examination, blood chemistries,blood coagulation function,and D-dimer. One year survival time of the patients and deathreason were followed up. SPSS18software was used in statistic analysis，t-test was usedin measurement data， x2test was used in enumeration data，and unconditional Logisticregression model（Wald test）was used to screen independent risk factors. Receiveroperating characteristic was plotted and the area under the curve was calculated to evaluatethe diagnose performance. Complications and survival time of two group patients wereanalyzed with statistic analysis, single factor survival curve comparison (Kaplan-Meiermethod) was used to calculate and draw survival curve,and the death cause was analyzed.Result: In totally294patients,55cases complicated with PVT, morbidity was18.71%.Thrombus in MPV was the most common, total were43cases(78%).Study onwhite blood cell, hemoglobin, total bilirubin, creatinine, serum natrium, prothrombintime, activated partial prothrombin time， fibrinogen,international normalized Ratio withsimilar results, there were no significant statistical difference between thrombus group andcontrol group(P>0.05). The platelet and albumin level of thrombus group were lower than control group（92.55±23.04vs99.66±20.23×109/L，P=0.038；32.53±2.324vs33.36±3.622g/L，P=0.036）, the level of D-dimer was higher（1.00±0.22vs0.77±0.15mg/L,P=0.001）,width of main portal vein was broadening（15.11±1.32vs13.40±1.43mm,P=0.001）, portalvein velocity flowed slower（13.51±1.51vs15.16±1.60cm/s，P=0.001）, spleen thicknesswas thicker（59.35±5.45vs57.64±5.92mm,P=0.043）, the difference were statisticallysignificant. Analysis of unconditional Logistic regression model indicate that D-dimer,PVV and MPV were single hazard factors of PVT in cirrhosis paitients（P=0.001，0.019，0.024；OR：10.07，9.489，7.616）.ROC was plotted and the AUC was calculated to evaluatethe diagnose performance indicated that D-dimer> PV V> MPV （AUC：0.800>0.738>0.729）. Percentage of complications with severe esophageal varices, uppergastrointestinal hemorrhage and massive ascites were greater than control group, thedifference were statistically significant (P<0.05). Compared with Hepatic encephalopathy,the difference was not statistically significant (P>0.05). Single factor survival curve（Kaplan-Meier method）（one year after diagnosed）was used to calculate and drawsurvival curve, survival period of thrombus group was shorter control group, the differencewas statistically significant (P<0.05). Upper gastrointestinal hemorrhage and massiveascites were the major causes of death in thrombus group（37.5%，31.25%）.Summary1. D-dimmer, MPV, PVV were single hazard factors of PVT in cirrhosispaitients. The higher the level of D-dimer was, the wider MPV was，and the slower PVVwas,the incidence of PVT would be higher.2. The incidence of severe esophageal varices, upper gastrointestinal hemo-rrhage and massive ascites in the cirrhosis patients complicated with PVT weresignificantly increased.3. One year survival time of the cirrhosis patients with PVT were shorter thanthose without PVT. Most of them died of upper gastrointestinal hemorrhage and massiveascites.