目的 探讨肝硬化并发门静脉血栓形成的危险因素.方法 选取我院2013年1月～2018年1月确诊的肝硬化患者69例, 其中经腹部CT或腹部超声诊断为门静脉血栓患者24例设为血栓组, 未发生血栓患者45例设为对照组.回顾性分析肝硬化门静脉血栓患者与肝硬化非血栓患者的年龄、性别、肝硬化病因;比较两组患者的D-二聚体、白细胞计数 (WBC) 、血红蛋白 (Hb) 、血小板 (PLT) 、肌酐 (Cr) 、凝血酶原时间 (PT) 、活化部分凝血活酶时间 (APTT) 、纤维蛋白原 (Fib) 、血清总胆红素 (TBIL) 、直接胆红素 (DBIL) 、白蛋白 (ALB) 、丙氨酸氨基转移酶 (ALT) 、天门冬氨基转移酶 (AST) 、γ-谷氨酰转肽酶 (GGT) 、血氨浓度、门静脉内径宽度 (MVP) 、脾脏厚度、脾切除史、有无合并食管胃底静脉曲张出血及腹腔积液.结果 两组性别、年龄、肝硬化病因、腹腔积液并发症比较, 差异无统计学意义 (P＞0.05) , 两组食管静脉曲张破裂出血并发症比较, 差异有统计学意义 (P＜0.05) .血栓组腹部超声或螺旋CT增强扫描显示:门静脉主干血栓22例 (91.67％) (1例合并肠系膜上静脉血栓, 6例合并左/右门静脉分支, 1例合并左/右门静脉分支及肠系膜上静脉血栓) , 单纯位于左/右门静脉分支2例 (8.33％) ;两组患者中D-二聚体、AST、ALT、ALB、PTA、PLT差异存在统计学意义 (P＜0.05) ;Logistic回归模型分析显示, D-二聚体、门静脉内径宽度、Hb是肝硬化门静脉血栓形成的独立危险因素 (P＜0.05) .结论 肝硬化患者应加强对患者D-二聚体、血红蛋白、门静脉内径宽度的监测, 有助于患者疾病早期诊断和治疗.%Objective To investigate the risk factors of patients with cirrhosis complicated by portal venous thrombosis.Methods 69 patients with liver cirrhosis diagnosed in our hospital from January 2013 to January 2018 were selected, among which, 24 patients with portal vein thrombosis diagnosed by abdominal CT or abdominal ultrasound were divided into the thrombosis group, and 45 patients without thrombosis were divided into the control group.The age, sex and etiology of cirrhotic portal vein thrombosis and non-thrombotic cirrhosis were analyzed retrospectively.The D-dimer, White blood cell count (WBC) , hemoglobin (Hb) , platelets (PLT) , creatinine (Cr) , prothrombin time (PT) , activated partial thrombin time (APTT) , fibrinogen (Fib) , serum total bilirubin (TBIL) , direct bili-rubin (DBIL) , albumin (ALB) , alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , gamma-glutamyltransferase (GGT) , blood ammonia concentration, history of splenectomy, portal vein width (MPV) , Thickness of spleen, esophageal vaficeal bleeding, ascites were compared between two groups.Results There were no significant difference in sex, age, causes of cirrhosis between thrombosis group and control group (P＞0.05) .The complications of esophageal variceal bleeding in the two groups were significantly different (P＜0.05) .Abdominal ultrasound or spiral CT enhanced scan showed 22 cases (91.67％) of portal vein thrombosis in thrombus group (1 case with superior mesenteric vein thrombosis, 6 cases with left/right portal vein branch, 1 case with left/right portal vein branch and 1 case with superior mesenteric vein thrombosis) .2 cases were located in left/right portal vein branch (8.33％) .There was significant difference in D-dimer and AST, ALT, ALB, PTA, PLT between the two groups (P＜0.05) .Logistic regression analysis showed that D-dimer, diameter width of portal vein and Hb were independent risk factors of portal vein thrombosis in liver cirrhosis (P＜0.05) .Conclusion The monitoring of D-dimer, hemoglobin and portal vein diameter should be strengthened in patients with liver cirrhosis, which is helpful to the early diagnosis and treatment of patients with liver cirrhosis.
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