Epidemiological investigation of cirrhotic patients with cavernous transformation of portal vein
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摘要: 目的 了解新疆维吾尔自治区肝硬化合并门静脉海绵样变性(CTPV)的现况，研究肝硬化合并CTPV的患病率并分析相关危险因素。方法 系统收集2016年1月—2020年12月新疆维吾尔自治区6家公立三甲医院中肝硬化患者的基本信息，对其年龄、性别、体重指数、肝硬化病因、Child-Pugh分级、腹水、食管胃底静脉曲张程度、门静脉血栓形成、总胆红素、凝血酶原活动度(PTA)、白蛋白、AST以及ALT进行统计分析。比较不同性别、年份、年龄段肝硬化合并CTPV患病率，将纳入研究的所有肝硬化患者根据是否合并CTPV分为CTPV组和N-CTPV组，运用t检验或χ2检验比较2组相关临床特征，运用logistic多元回归分析获得发生肝硬化发生CTPV的独立危险因素。结果 2016年1月—2020年12月5年间在5368例肝硬化患者中共检出671例合并CTPV，患病率为12.5%，肝硬化CTPV发病率从2016年的10.5%逐渐上升至2020年的15.1%，男性和女性肝硬化患者CTPV发病率总体趋势是随年龄的增大而增加，50~60年龄段发病率达到峰值。与N-CTPV组相比，CTPV组总胆红素明显高于N-CTPV组，PTA明显低于N-CTPV组，且2组间差异有统计学意义，男性、Child-Pugh分级C级、腹水、重度食管胃底静脉曲张程度、门静脉血栓形成的患病率亦明显高于N-CTPV组，2组间差异有统计学意义。logistic多元回归分析校正和控制混杂变量后，性别、腹水、重度食管胃底静脉曲张程度以及门静脉血栓形成为肝硬化合并CTPV的独立危险因素，以门静脉血栓形成相对风险度最高(OR=27.643，95%CI：15.321~38.143，P< 0.001)。结论 我区的肝硬化患者CTPV的发病率在2016—2020年呈现逐步上升的趋势，男性发病率高于女性，男性、腹水、重度食管胃底静脉曲张程度以及门静脉血栓形成是肝硬化患者发生CTPV的独立危险因素。Abstract: Objective To understand the current situation of cirrhotic patients with cavernous transformation of portal vein(CTPV) in Xinjiang Urgur Autonomous Region of China to study the prevalence of cirrhotic patients with CTPV and to analyze the related risk factors.Methods The basic information of cirrhotic patients in six public hospitals in our district from January 2016 to December 2020 was collected, and their age, gender, body mass index, etiology of liver cirrhosis, Child-Pugh grade, ascites, degree of esophageal and gastric varices, portal vein thrombosis, total bilirubin, PTA, albumin, AST and ALT were statistically analyzed. The prevalence of cirrhosis with CTPV was compared in different gender, year and age groups. All cirrhotic patients were divided into CTPV group and N-CTPV group according to whether they were complicated with CTPV. The clinical characteristics of the two groups were compared byttest orχ2test, and logistic multiple regression analysis was used to obtain the independent risk factors of CTPV in cirrhotic patients.Results From January 2016 to December 2020, 671 cases were diagnosed with CTPV in the 5368 cases of cirrhosis, with a prevalence of 12.5%. The incidence rate of CTPV in cirrhosis increased from 10.5% in 2016 to 15.1% in 2020. The incidence rate of CTPV in male and female cirrhotic patients increased with age and the peak incidence rate was in 50-60 years age group. Compared with N-CTPV group, the total bilirubin in CTPV group was significantly higher than that in N-CTPV group, and the PTA was significantly lower than that in N-CTPV group, and the differences between the two groups were statistically significant. The prevalence of male, Child-Pugh grade C, ascites, severe esophageal and gastric varices, and portal vein thrombosis in CTPV group were also significantly higher than those in N-CTPV group, after adjusting and controlling for confounding variables by logistic regression analysis, gender, ascites, severe degree of esophageal and gastric varices and portal vein thrombosis were independent risk factors of CTPV in cirrhosis, and the relative risk of portal vein thrombosis was the highest(OR=27.643, 95%CI: 15.321-38.143,P< 0.001).Conclusion The incidence rate of CTPV in cirrhosis of our district increased gradually from 2016 to 2020. The incidence rate of male was higher than that of female. Male, ascites, severe degree of esophagogastric varices and portal vein thrombosis were independent risk factors of CTPV in cirrhotic patients.
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表 1 不同性别、年份肝硬化合并CTPV患病率
年份 男性 女性 总计 发病数/例 总例数/例 发病率/% 发病数/例 总例数/例 发病率/% 发病数/例 总例数/例 发病率/% 2016 73 631 11.6 25 301 8.3 98 932 10.5 2017 101 746 13.5 31 357 8.7 132 1103 12.0 2018 113 812 13.9 34 414 8.2 147 1226 12.0 2019 125 778 16.1 27 409 6.6 152 1169 13.0 2020 121 653 18.5 21 285 7.4 142 938 15.1 总计 533 3620 14.7 138 1748 7.9 671 5368 12.5 
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表 2 不同性别、年龄段肝硬化合并CTPV患病率
年龄/岁 男性 女性 总计 发病数/例 总例数/例 发病率/% 发病数/例 总例数/例 发病率/% 发病数/例 总例数/例 发病率/% < 20 0 8 0 0 0 0 0 8 0 20~ < 30 8 151 5.3 2 44 4.5 10 195 5.1 30~ < 40 58 511 11.4 13 163 7.9 71 674 10.5 40~ < 50 145 1095 13.2 37 383 9.7 182 1478 12.3 50~ < 60 166 998 16.6 38 378 10.0 204 1376 14.8 60~ < 70 128 832 15.4 21 272 7.7 149 1104 13.5 ≥70 45 376 12.0 10 157 6.4 55 533 10.3 总计 533 3620 14.7 138 1748 7.9 671 5368 12.5
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表 3 肝硬化CTPV组和N-CTPV组相关临床因素比较
例 临床因素 CTPV组(n=671) N-CTPV组(n=4697) t/χ2 P 性别 13.245 ＜0.001 男 533 3087 女 138 1610 年龄/岁 51.2±9.5 48.3±9.6 0.982 0.432 BMI/(kg/m2) 26.5±5.8 25.3±5.7 0.873 0.557 肝硬化病因 1.765 0.286 乙肝 452 3567 丙肝 104 632 脂肪肝 52 265 其他 63 233 Child-Pugh分级 5.679 0.018 A级 82 659 B级 386 2478 C级 203 1560 腹水 10.198 0.002 有 502 2876 无 169 1821 静脉曲张程度 9.274 0.006 轻度 21 1323 中度 368 2657 重度 282 717 门静脉血栓形成 36.789 ＜0.001 有 634 823 无 37 3874 白蛋白/(g·L-1) 27.2±5.7 29.2±5.5 2.097 0.175 总胆红素/(μmol·L-1) 83.4±21.6 52.7±25.9 11.234 ＜0.001 PTA/% 56.2±23.8 77.1±22.1 5.123 0.021 AST/(U·L-1) 92.4±31.3 83.5±30.7 3.019 0.084 ALT/(U·L-1) 101.7±33.4 94.5±28.9 2.746 0.114
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表 4 肝硬化合并CTPV多因素logistic回归分析
自变量 β SE HR 95%CI P 性别 1.454 0.224 3.246 2.235~4.156 ＜0.001 腹水 1.207 0.315 2.986 1.867~3.824 0.007 静脉曲张程度 1.032 0.256 2.803 1.712~3.763 0.011 门静脉血栓形成 4.563 0.185 27.643 15.321~38.143 ＜0.001
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