Analysis Of Clinical Characteristics And Risk Factors Of 156 Patients With Cirrhosis Of Portal Vein Thrombosis

Objective:Retrospective analysis of clinical characteristics and risk factors of 156 patients with cirrhosis of portal vein thrombosis.MATERIALS AND METHODS:A total of 156 cirrhosis patients with portal vein thrombosis who were admitted to the Department of Hepatobiliary and Pancreatic Medicine in our hospital from January 2015 to July 2020 meeting the inclusion criteria and exclusion criteria were selected,and 160decompensated cirrhosis patients who were hospitalized during the same period were randomly selected.We divide these patients into PVT group and non-PVT group.Patients in PVT group were further divided into single-vessel thrombus group(thrombus involved only one vessel,n=30)and multi-vessel thrombus group(thrombus involved site≥2,n=126)according to the scope of thrombus involvement.We collected the general information,past medical history,laboratory indexes,imaging examination results,gastroscopy results and complications of these patients,and using the SPSS 26.0 software for statistical analysis.Using Logistic regression analysis to summarize the independent risk factors for cirrhosis with portal vein thrombosis.Result:(1)There was no significant difference in age,gender,etiology of liver cirrhosis,smoking history,drinking history,diabetes history and hypertension history between the two groups(P>0.05).The proportion of patients with previous gastrointestinal bleeding history,endoscopic treatment history and splenectomy history in PVT group was higher than that in non-PVT group(P<0.05).The hospitalization time,MELD score and Child-Pugh score of PVT group were higher than those of non-PVT group(P<0.05).(2)The RBC、Hb、ALT、AST、GGT、ALP、CHE、TP、ALB、TC、TG、LDL、and Na~+in PVT group were significantly lower than those in non-PVT group(P<0.05),the WBC、INR、diameter of main portal vein and thickness of spleen in PVT group were significantly higher than those in non PVT group(P<0.05).(3)The main portal vein(91.0%),branches of portal vein(66.0%),superior mesenteric vein(45.5%)and splenic vein(26.9%)were the most common sites of PVT.The main portal vein+branches of portal vein(25.6%)was the most common site,followed by main portal vein+branches of portal vein+superior mesenteric vein(14.7%).The diameter of portal vein trunk was wider and MELD score was higher in patients with multi vessel thrombosis than in patients with single vessel thrombosis.(4)Compared with non-PVT group,the incidence of severe esophageal varices,gastrointestinal bleeding,ascites,SBP and hepatic encephalopathy was higher in PVT group(P<0.05).(5)Splenectomy(OR=4.501,P=0.002),widened main portal vein diameter(OR=1.472,P<0.001),increased Child Pugh score(OR=1.373,P=0.010)and decreased TG(OR=0.297,P=0.001)were independent risk factors for PVT in cirrhosis.The diameter of the main portal vein is the most valuable in predicting the formation of PVT in cirrhosis,the area under ROC curve was 0.731(95%CI:0.676-0.785,P<0.001).When the diameter of the main portal vein was 14.45mm,the sensitivity and specificity of PVT were 84.6%and 50.0%,respectively.Conclusion:(1)The most common sites of portal vein thrombosis were the main portal vein,portal vein branch,superior mesenteric vein and splenic vein,among which the main portal vein+portal vein branch was the most commonly involved,followed by the main portal vein+portal vein branch+superior mesenteric vein.(2)Compared with patients with single thrombus,patients with multiple thrombus had higher portal pressure and worse liver function.(3)PVT is more likely to occur in the late stage of cirrhosis.Compared with simple cirrhosis,PVT patients with cirrhosis have longer hospitalization time,and are more prone to esophageal varices,gastrointestinal bleeding,ascites,SBP,hepatic encephalopathy and other complications.(4)The increase of splenectomy,the widening of portal vein diameter,the increase of Child Pugh score and TG decrease were independent of the formation of PVT in cirrhosis.The value of the portal vein diameter in predicting PVT formation in cirrhosis was the highest.Clinically,the risk of PVT formation in cirrhosis is significantly increased when abdominal color ultrasound indicates that the inner diameter of portal vein trunk is greater than or equal to 15mm.