| Objective:To investigate the clinical features of acute pancreatitis(AP)complicated with portal vein system thrombosis(PVST)and clinical prediction of symptomatic PVST.Methods:Retrospective research methods were used to include inpatients of AP from January 2014 to December 2019 in the First Affiliated Hospital of Kunming Medical University and the Second Affiliated Hospital of Kunming Medical University who complicated with PVST diagnostic criteria and had complete clinical data.Divided into two groups according to the clinical manifestations caused by PVST(esophagogastric variceal bleeding,persistent ascites,intestinal ischemia):symptomatic group and asymptomatic group.The general data,laboratory test results,and various scoring systems were compared between the two groups,and statistically significant indicators were analyzed by multivariate regression.To investigate the clinical features of acute pancreatitis(AP)complicated with portal vein system thrombosis(PVST)and clinical prediction of symptomatic PVST.Results:1 General information1.1 Incidence of PVST A total of 1,048 patients who met the AP diagnosis and abdominal CT enhancement/three-dimensional reconstruction from Kunming Medical University First Affiliated Hospital and Kunming Medical University Second Affiliated Hospital,152 patients with AP complicated with PVST were included.The incidence of AP with PVST was 14.5%(152/1048).1.2 Age The age of patients with AP complicated by PVST was 48.78±14.61(years);The age of the patients in the symptom group was 50.67±14.02(years),and the age of the asymptomatic group was 47.91 ± 14.86(years),the difference was not statistically significant(P>0.05).1.3 Gender There were 110 male patients(72.37%)and 42 female patients(27.63%)of AP with PVST.There were no statistically significant differences between 34 males(70.83%)and 14 females(29.17%)in the symptom group and 76 males(73.08%)and 28 females(26.92%)in the asymptomatic group(P>0.05).1.4 Hospital stay The hospitalization time in AP patients with PVST was 14.61 ±12.26(days).The hospitalization time in the symptom group was 26.31±19.38(days)higher than that in the asymptomatic group 15.11 ± 9.31(days),and the difference was statistically significant(P<0.05 or P<0.01).1.5 Hospital costs The hospitalization cost of patients with AP complicated with PVST was 58124.95 ± 6277.72(yuan),The hospitalization cost of symptomatic group was 103463.68 ± 15312.74(yuan),which was higher than that of asymptomatic group 37199.3 8 ± 4647.17(yuan),the difference was statistically significant(P<0.05 or P<0.01).1.6 Past history There were 33 patients(21.71%)with a history of pancreatitis in AP with PVST,and 72 patients(47.37%)with a history of smoking.The history of pancreatitis in the symptomatic group(16.67%)and smoking history(39.58%)were lower than those in the asymptomatic group(24.04%,50.96%),and the differences were not statistically significant(P>0.05).1.7 Causes Drinking is the most common cause of AP and PVST.Among the causes of AP-complicated PVST,there were 47 cases(30.92%)of drinking alcohol,33 cases of biliary disease origin(21.71%),22 cases of dietary factors(14.47%),4 cases of autoimmune(2.63%),4 cases of other causes(2.63%),7 cases(4.61%)with two or more causes,and 35 cases(23.03%)with no obvious cause.in the symptom group Drinking(22.92%),origin of biliary diseases(20.83%),dietary factors(14.58%)compared with drinking(34.62%),origins of biliary diseases(22.12%),dietary factors(14.42%)in the asymptomatic group,The results were not statistically different(P>0.05).2 Distribution of vascular involvement in portal vein system The splenic vein(SV)is the most commonly involved blood vessel in AP with PVST.SV(46.05%)was the most affected single blood vessel,followed by portal vein(PV)and superior mesenteric vein(SMV)(15.79%,5.93%);the most frequently involved form of blood vessels was PV+SV+SMV(12.5%).SMV(16.67%)in the symptomatic group was higher than that in the asymptomatic group(0.96%),and the difference was statistically significant(P<0.05 or P<0.01).3 PVST and severity of AP According to the severity classification of acute pancreatitis,MAP was 6.58%(10/152),MSAP was 20.39%(31/152),SAP was 73.03%(111/152),and in-hospital mortality was 14.47%(22/152),including 21 cases of SAP,1 case of MSAP,and no death in MAP.Patients with SAP and pancreatic necrosis are more likely to have PVST-induced clinical manifestations,and patients with symptomatic PVST are more likely to have other complications and have a higher hospital mortality.PVST-induced clinical manifestations:the incidence of esophagogastric varices bleeding(EVB)was 3.95%,persistent ascites was 19.74%,and intestinal ischemia was 12.5%.SAP in the symptomatic group(97.92%),pancreatic necrosis(87.5%),and hospital mortality(25%)were higher than those in the asymptomatic group(61.54%,28.85%,9.62%),and the differences were statistically significant(P<0.05 or P<0.01).Hyperlipidemia(47.92%),abdominal hemorrhage(10.42%),shock(18.75%),ARDS(25%),pulmonary infection(91.67%),and pleural effusion(85.42%)in the symptom group were higher than the asymptomatic group complicated by hyperlipidemia(29.81%),abdominal hemorrhage(1.92%),shock(1.92%),ARDS(3.85%),pulmonary infection(60.58%),and pleural effusion(49.04%),all were statistically significant(P<0.05 or P<0.01).There were no significant differences in the complications of pancreatic encephalopathy,liver injury,kidney injury,and spleen infarction between the two groups(P>0.05).4 Imaging performance Pancreatic hypertension occurred in 31 patients(20.39%)in AP with PVST.Characteristic imaging findings included Gastroesophageal Varices(GOV)of 20.39%(31/152),splenomegaly of 19.08%(29/152),and the branch circulation opening of 15.13%(23/152).The GOV(25%)and splenomegaly(22.92%)in the symptom group were higher than those in the asymptomatic group(18.27%,17.31%),the open collateral circulation around the symptom group(10.41%)was lower than the asymptomatic group(17.41%).No statistical significance(P>0.05),there were not significantly different(P>0.05).5 Comparison of BMI and laboratory inspection data LDH,CRP,and PT were higher in the symptomatic group than in the asymptomatic group,and HCT and blood calcium were lower than those in the asymptomatic group,and the differences were statistically significant(P<0.05 or P<0.01),There were no significant differences in BMI,WBC,PLT,ALT,AST,BUN,TC,TG,AMY,LIP,FIB,D-D between the two groups(P>0.05).6 Comparison of Score systems The APACHEII score(7.21 ± 3.84)and Balthazar CT score(7.10 ± 1.57)in the symptom group were higher than those in the asymptomatic group(5.27± 2.31,4.83±1.87),and the differences were statistically significant(P<0.05 or P<0.01).7 Independent risk factors for symptomatic PVST Multivariate binary Logistic regression analysis showed that:Balthazar CT score(OR=1.61,95%CI=1.12-2.31),superior mesenteric venous thrombosis(SMVT)(OR=1.95,95%CI=1.45-34.23)are independent risk factors for symptomatic PVST.Conclusions:1.The incidence of AP concurrent PVST was 14.5%,the hospital mortality was 14.47%,and the incidence of pancreatic hypertension was 20.39%.Drinking(30.92%)was the main cause,followed by the origin of biliary diseases(21.71%).SV(46.05%)was the most commonly affected blood vessel.Among 152 patients,10 were MAP(6.58%),31 were MSAP(20.39%),and 111 were SAP(73.03%),PVST was more common in SAP.2.PVST-induced clinical manifestations:the incidence of esophagogastric variceal bleeding(EVB)was 3.95%,persistent ascites was 19.74%,and intestinal ischemia was 12.5%.3.Symptomatic PVST was not significantly associated with patient age,gender,Previous history of pancreatitis,smoking history,etiology,and BMI value.4.Symptomatic PVST is closely related to the severity of AP.The hospitalization time,hospitalization cost,hospital mortality,vascular involvement,pancreatic necrosis,extra-pancreatic complications,APACHEII score,Balthazar CT score,LDH,CRP,PT,HCT,blood calcium in the symptom group were significantly different from those in the asymptomatic group.5.Balthazar CT score and SMVT are independent risk factors for symptomatic PVST.6.It is recommended that patients with MSAP and SAP should complete abdominal vascular imaging examination,dynamically review if necessary,and improve Balthazar CT score to assess the patient's condition,and early intervention treatment for AP patients with SMVT to minimize the clinical manifestations caused by PVST.Probability,to reduce hospitalization time,hospitalization cost,and even improve patient prognosis and survival. |
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