摘要
【目的】探讨影响肝硬化患者形成门静脉血栓(PVT)的危险因素和PVT患者的中医证型分布规律。【方法】回顾性分析深圳市中医院2017年1月1日至2022年3月31日收治的475例肝硬化患者的临床资料,根据是否并发PVT分为PVT组62例和非PVT组413例。采用t检验、秩和检验及χ2检验对2组患者的临床资料进行分析,并采用多因素Logistic回归模型分析肝硬化合并PVT的危险因素。【结果】(1)中医证型分布方面,PVT组中,气虚血瘀证所占比例最大,占29.03%(18/62),其次为湿热瘀阻证,占27.42%(17/62),其他依次为气滞血瘀证[16.13%(10/62)]、肝郁脾虚证[14.52%(9/62)]、肝肾两虚证[12.90%(8/62)]。非PVT组中,肝郁脾虚证所占比例最大,占29.06%(120/413),其余证型所占比例大致相当,分别为气虚血瘀证[19.61%(81/413)]、肝肾两虚证[17.43%(72/413)]、气滞血瘀证[16.95%(70/413)]和湿热瘀阻证[16.95%(70/413)]。(2)单因素分析结果显示:PVT组与非PVT组在谷草转氨酶(AST)、总胆红素(TB)、白蛋白(ALB)、碱性磷酸酶(ALP)、血红蛋白(HB)、D-二聚体(D-D)、门静脉主干内径、终末期肝病模型(MELD)评分、Child-Pugh分级、年龄、是否脾切除、是否有食管胃底静脉破裂出血史、是否有腹水及中医证型分布方面均存在显著性差异(P<0.05或P<0.01)。(2)多因素Logistic回归模型分析结果显示:是否脾切除[OR=5.068,95%CI(2.073-12.390)]、有无胃底静脉曲张破裂出血史[OR=2.441,95%CI(1.201-4.961)]、门静脉主干内径[OR=1.370,95%CI(1.191-1.575)]为影响肝硬化患者并发PVT的独立危险因素(P<0.05或P<0.01)。【结论】肝硬化并PVT患者以气虚血瘀证占比最多;门脉主干内径增宽、行脾切除术及有食管胃底静脉破裂出血史是肝硬化患者并发PVT的独立危险因素。
Objective To investigate the risk factors of portal vein thrombosis(PVT)in patients with liver cirrhosis and to explore the distribution pattern of traditional Chinese medicine(TCM)syndrome in patients with PVT.Methods The clinical data of 475 patients with liver cirrhosis admitted to Shenzhen Traditional Chinese Medicine Hospital from 1 January 2017 to 31 March 2022 were retrospectively analyzed.The patients were divided into the PVT group(62 cases)and the non-PVT group(413 cases)according to the presence of the complication of PVT.The clinical data were tested by t test,rank sum test,and chi-square test.Multivariate logistic regression analysis was used for the exploration of risk factors of liver cirrhosis complicated with PVT.Results(1)The analysis of the distribution of TCM syndrome types showed that the syndrome of qi deficiency and blood stasis accounted for the most[29.03%(18/62)]in the PVT group,followed by the damp-heat and blood stasis obstruction syndrome[27.42%(17/62)],qi stagnation and blood stasis syndrome[16.13%(10/62)],liverdepression and spleen-deficiency syndrome[14.52%(9/62)],and liver and kidney deficiency syndrome[12.90%(8/62)].In the non-PVT group,the liver-depression and spleen-deficiency syndrome accounted for the largest proportion[29.06%(120/413)],followed by qi deficiency and blood stasis syndrome[19.61%(81/413)],liver and kidney deficiency syndrome[17.43(72/413)],qi stagnation and blood stasis syndrome[16.95%(70/413)],and damp-heat and blood stasis obstruction syndrome[16.95%(70/413)].(2)Univariate analysis showed that significant differences were shown in the aspartate aminotransferase(AST),total bilirubin(TB),albumin(ALB),alkaline phosphatase(ALP),hemoglobin(HB),D-dimer(D-D),diameter of portal vein trunk,scores of model for end-stage liver disease(MELD),Child-Pugh grading,age,splenectomy or not,presence of the history of gastroesophageal variceal bleeding or not,ascites or not,and the distribution of TCM syndrome types when compared between PVT group and non-PVT group(P<0.05 or P<0.01).(3)The results of multivariate logistic regression analysis showed that splenectomy or not[OR=5.068,95%CI(2.073-12.390)],presence of the history of gastroesophageal variceal bleeding or not[OR=2.441,95%CI(1.201-4.961)],and the diameter of portal vein trunk[OR=1.370,95%CI(1.191-1.575)]were the independent risk factors for the complication of PVT in patients with liver cirrhosis(P<0.05 or P<0.01).Conclusion Patients with liver cirrhosis complicated with PVT usually have the syndrome of qi deficiency and blood stasis,and the widening of the diameter of the portal vein trunk,splenectomy and the history of gastroesophageal variceal bleeding are the independent risk factors for the complication of PVT in patients with liver cirrhosis.
作者
刘蒙
林尚明
刘林华
贺劲松
LIU Meng;LIN Shang-Ming;LIU Lin-Hua;HE Jin-Song(The Fourth Clinical Medical School of Guangzhou University of Chinese Medicine,Shenzhen 518033 Guangdong,China;Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033 Guangdong,China)
出处
《广州中医药大学学报》
CAS
2023年第11期2702-2707,共6页
Journal of Guangzhou University of Traditional Chinese Medicine
基金
广州中医药大学2021年度研究生科研创新项目(编号:A1-2606-21-429-001Z60)。
关键词
肝硬化
门静脉血栓(PVT)
中医证型
气虚血瘀证
危险因素
live cirrhosis
portal vein thrombosis
traditional Chinese medicine(TCM)syndrome types
qi deficiency and blood stasis syndrome
risk factors
