文章摘要

Budd-Chiari综合征并发门静脉血栓形成的危险因素分析

作者: 1党晓卫, 1刘优优, 1李林, 1李路豪, 1付坤坤, 1牛光辉, 1李松, 1许培钦
1 郑州大学第一附属医院 肝胆胰腺外科，河南 郑州 450052
通讯: 党晓卫 Email: dangxw1001@163.com
DOI: 10.3978/.10.3978/j.issn.1005-6947.2017.03.011
基金: 河南省科技厅科技计划基金资助项目 , 132102310424 河南省卫生和计划生育委员会科研基金资助项目, 201403032

摘要

目的：探讨Budd-Chiari综合征（BCS）并发门静脉血栓形成（PVT）的相关危险因素。方法：回顾性分析郑州大学第一附属医院2010年1月—2015年12月确诊的28例BCS并发PVT患者（PVT组）与随机选取同期确诊的40例BCS未并发PVT的患者（非PVT组）的临床资料。采用单因素分析及二分类多因素非条件Logistic回归模型筛选出BCS并发PVT的独立危险因素，用受试者工作特性曲线（ROC）与曲线下面积（AUC）分析各危险因素的诊断效能，并计算最佳临界点。结果：单因素分析显示，PVT组患者在门静脉血流速度、血红蛋白明显低于非PVT组，D-二聚体（DD）、脾脏厚度水平明显高于非PVT组（均P<0.05）；非条件Logistic回归模型分析显示血浆DD、门静脉血流速度、脾脏厚度是BCS并发PVT的独立危险因素（OR=31.67、0.61、1.23，均P<0.05）。ROC曲线显示，门静脉血流速度对BCS并发PVT无诊断价值（AUC<0.5），而DD、脾脏厚度的AUC分别为0.724、0.673，诊断BCS并发PVT的最佳临界点分别为0.283 μg/L、49.5 mm。结论：血浆DD水平、门静脉血流速度、脾脏厚度是BCS并发PVT的独立危险因素，尤其是DD>0.283 μg/L、脾脏厚度>49.5 mm的BCS患者，PVT发生的可能性增大。
关键词： Budd-Chiari综合征 门静脉 静脉血栓形成 危险因素

Analysis of risk factors for Budd-Chiari syndrome with complicated portal vein thrombosis

Authors: 1DANG Xiaowei, 1LIU Youyou, 1LI Lin, 1LI Luhao, 1FU Kunkun, 1NIU Guanghui, 1LI Song, 1XU Peiqin
1 Department of Hepatopancreatobiliary Surgery, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China

CorrespondingAuthor:DANG Xiaowei Email: dangxw1001@163.com

Abstract

Objective: To investigate the factors for Budd-Chiari syndrome (BCS) with complicated portal vein thrombosis (PVT). Methods: The clinical data of 28 patients diagnosed as BCS with complicated PVT (PVT group) in the First Affiliated Hospital of Zhengzhou University from January in 2010 to December 2015, and 40 patients diagnosed as BCS without PVT (non-PVT group) in the same period by random pick were retrospectively analyzed. The risk factors for BCS with complicated PVT were screened by univariate analysis and unconditional Logistic regression model. The diagnostic efficiency of each risk factor was analyzed by receiver operating characteristic curve (ROC) and the area under ROC curve (AUC), and their optimal cut-off values were also determined. Results: Univariate analysis showed that the velocity of the portal vein blood flow and the hemoglobin level were significantly lower and the D-dimer (DD) level and splenic thickness were significantly higher in PVT group than those in non-PVT group (all P<0.05); the results of unconditional Logistic regression model analysis identified that DD level, velocity of the portal vein blood flow and splenic thickness were independent risk factors for BCS with complicated PVT (OR=31.67, 0.61 and 1.23, all P<0.05). ROC curve demonstrated that the velocity of the portal vein blood flow had no diagnostic value for BCS with complicated PVT (AUC<0.5), while the AUC of DD level and splenic thickness for prediction of BCS with complicated PVT was 0.724 and 0.673 with the optimal cut-off value of 0.283 μg/L and 49.5 mm, respectively. Conclusion: Serum DD level, velocity of the portal vein blood flow, and splenic thickness are independent risk factors for BCS with complicated PVT, and the possibility of PVT is increased especially in BCS patients with DD level higher than 0.283 μg/L or splenic thickness greater than 49.5 mm.
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