| Objective: To evaluate the risk factors of portal vein thrombosis(PVT) in paitients with cirrhosis, establish prediction models,and investigate the prognostic effect of PVT on patients with cirrhosis.Methods: Retrospective study was done in the paper.The cases of 93 cirrhosis patients with PVT,93 cases of cirrhosis patients without PVT were chosen to control group, those who were diagnosed from the first affiliated hospital of Fu Jian Medical University from Jun. of 2008 to Dec. of 2015. Through the adoption of using propensity matching to exclude confounding factors, 158 cases were included in the study. Patients were divided into two groups, of which 79 patients with PVT as thrombus group and other 79 patients without PVT cirrhosis as control group. The clinical data were recorded. SPSS20.0 software was used for statistical analysis.T-test, Mann-Whitney Test and chi-square test were applied to investigate the difference of coagulation,liver function, complications related to cirrhosis ect.Binary Logistic Analysis was used to identify independent risk factors of PVT and build predictive models. Kaplan-Meier method was used to compare and make a statistic analysis of the prognosis between the two groups,and calculate and plot the survival curve. P < 0.05 indicated that the difference is statistically significant.Results:1. There are no significant differences among groups on ages,sex, diabetes, hypertension, the causes of liver cirrhosis.2. The main cause of liver cirrhosis is associated with hepatitis B, The incidence of PVT site is most common in portal vein trunk(55.7%).3. By univariate analysis, RBC,Hb, ALT, AST, ALb, CHE, TG?TCHO?APO(B) in PVT group were significantly lower than the control group(P<0.05), While the results of PT, D-D, Child-Pugh score were significantly higher than control group. The incidence of Splenectomy, pericardial devascularization, Gastroesophageal varices,esophagogastric variceal bleeding, ascites, Spontaneous bacterial peritonitis, Other infections were significantly higher than the control group.4. According to the result by comparing the analysis of single factor and unconditional logistic regression model, Hb, D-D, splenectomy, SBP, esophageal varices were screened as independent risk factors for cirrhosis PVT, Building Model =-0.731-0.018 ×(Hb) + 0.440 ×(D-D)+ 1.362 ×(splenectomy history) + 1.789 ×(SBP) + 1.368 ×(GOV),When receiver operating characteristic curves for the predictive models are fitted(P=0.220)and the area under the ROC curve(AUROC)of prediction model is 0.850, 95%CI(0.790-0.910),Sensitivity and specificity is 79.70% and 82.30%, respectively. And its positive predictive value(PPV) and negative predictive value(NPV) is 81.83% and 80.21%, respectively.5. Diagnostic curves of Hb,D-D on the PVT were built by ROC and the corresponding areas under AUROC were 0.722 and 0.764 respectively,Sensitivity and specificity is 70.90%,72.20% and 63.30%,70.90%, respectively.6. The incidence of esophagogastric variceal bleeding, refractory ascites happened during the follow-up in PVT group was higher than the control group, but there was no statistical significanceConclusions:1. The low hemoglobin, high D-dimer, splenectomy,spontaneous bacterial peritonitis, gastroesophageal varices were independent risk factors of PVT in cirrhosis. And build predictive model for PVT through these independent variables, which is quite valuable for diagnosis.2. Single factor of serum Hb or D-D were defined a certain predictive value for the diagnosis of PVT in cirrhosis.3. PVT had no significant effect on esophagogastric variceal bleeding, refractory ascites of liver cirrhosis. |
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