| Objective:To investigate the risk factors about portal vein thrombosis(PVT)forming in patients with liver cirrhosis and esophagogastric variceal bleeding.Methods:246 cases with esophagogastric variceal bleeding(EVB)admitted to the Gastroenterology Department of the Second Hospital of Shanxi Medical University in the first time from January 2012 to December 2020 were collected.110 cases were included according to the following selection criteria.Observe whether the included patients had portal vein thrombosis after the first hospitalization by searching their hospitalized medical records.They were divided into PVT group and non-PVT group.The observation time ranged from 3 months to 4 years.Analyze the clinical characteristics of patients,including gender,age,etiology of cirrhosis,past history(hypertension,diabetes,coronary heart disease,spontaneous peritonitis),personal history(smoking,drinking),non-selective beta blockers and Surgery(shunt or splenectomy)and other treatment history and laboratory indicators after admission include blood routine,biochemistry,coagulation function,Child-Pugh score,and history of endoscopic sclerosis hemostasis.SPSS 25.0 software was used for statistical analysis of the data.Normally distributed measurement data were expressed as mean±standard deviation,using t test and non-normally distributied measurement data were expressed as median(25th quantile,75th quantile),using rank sum test.Count data useχ~2test.Use unconditional logistic regression model to analyze the selected statistically significant indicators to screen out independent risk factors of PVT.P<0.05 indicates that the difference is statistically significant.Results:1、25 developed PVT Of the 110 patients with complete data,accounting for 22.73%of the enrolled patients.Among the 25 patients,someone took 12 days to form PVT after esophagogastric variceal bleeding.48%of them developed PVT within 1 year and 80%of them developed PVT within 2 years.2、Their age in PVT group ranged from 44 years old to 78 years old(59.64±9.56)(t=2.28,P=0.59).Among the 25 patients with PVT,there were 13 males(52%)and 14with viral cirrhosis,3 with alcoholic cirrhosis,2 cases with immune-related cirrhosis,and6 cases with unexplained cirrhosis and mixed etiology.Among them,4 cases of hypertension,13 cases of DM,no cases of coronary heart disease;9 cases of smoking,5cases of drinking;1 case took propranolol;and 4 cases combined with abdominal inflammation or tract inflammation;8 cases with previous splenectomy or TIPS;20 cases of ascites and 4 cases of hepatic encephalopathy in the first hospitalization.According to Child-Pugh score,1 case(4%)of grade A,9 cases of grade B(36%),15 cases(60%)of grade C;and 18 cases received endoscopic treatment among them.3、Among the 85 patients in non-PVT group,their age ranged from 29 years old to 85years old(58.25±11.89).There were 44 males(51.8%);and 36 with viral cirrhosis,15of alcoholic cirrhosis,23 cases with immune-related cirrhosis,11 cases with unexplained cirrhosis and mixed etiology;18 cases of hypertension,19 cases of DM,6 cases of coronary heart disease;24 cases of smoking,23 cases of drinking;10 cases of taking propranolol;8 cases combined abdominal inflammation or intestinal inflammation;4cases who received previously splenectomy or TIPS;and 50 cases of ascites and 4 cases of hepatic encephalopathy at the first hospitalization in this group.Among them,according to Child-Pugh score,there were 39 cases of grade A(45.9%),26 cases of grade B(30.57%),20 cases of grade C(23.53%);and 55 cases received endoscopic treatment.4、Univariate analysis showed that between the PVT group and the non-PVT group the differences in blood routine test,biochemical indicators,PT,APTT,ascites,hepatic encephalopathy,gender,age,history of vascular diseases and intestinal inflammation,personal history,history of NSBB and EVT were not statistically significant.The differences in Child-Pugh classification,diabetes,surgical and D-Dimer,FIB were statistically significant.5、Multivariate logistic regression analysis showed that Child-Pugh grading(P=0.044,OR value was 8.900,95%CI was 1.058-74.845),D-Dimer(P=0.040,OR value was1.001,95%CI was 1.000-1.001)and diabetes(P=0.032,OR value was 3.414,95%CI was 1.003-10.470)were independent risk factors for PVT formation in patients with liver cirrhosis and EVB.Conclusion:1、Child-Pugh grading,D-Dimer and diabetes can be relevant risk factors of PVT in patients with liver cirrhosis and EVB.2、Child-Pugh grading,D-Dimer and diabetes can be independent risk factors to predict the risk of PVT forming in patients with liver cirrhosis and EVB.The predictive value of D-Dimer is greater than the Child-Pugh score. |
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