门静脉血栓形成（PVT）与肝脏疾病的严重程度成正比。PVT通常伴随着肝脏疾病发病率和死亡率的升高，这可能会对肝移植候选患者造成影响。目前关于PVT和肝硬化患者进行抗凝治疗的数据有限。本研究目的旨在描述肝硬化和PVT患者血液高凝状态的发生率，并阐释对肝硬化和PVT患者进行抗凝治疗的结局。选用自2005年1月至2011年11月的等待肝移植的肝硬化患者作为回顾性队列。研究期间共有537例患者进行了肝移植的评估。13%的患者诊断为PVT。35%的患者患有慢性丙型肝炎，39%的患者患有肝细胞肝癌。共有22例患者进行了血液高凝状态的监测，有1例患者诊断为血液高凝状态。共有28例患者在研究期间接受了华法林治疗：门静脉血栓溶解患者占39%（11/28），门静脉血栓部分溶解患者占43%（12/28），还有18%的患者未见明显变化（5/28）。有8例患者在抗凝治疗过程中接受了肝移植治疗，手术证实所有患者（8例）的门静脉均开放。PVT在终末期肝病患者中较常见，其发生率为13%。在监测血液高凝状态的患者中有5%的患者被诊断为血液高凝状态。对于PVT患者，小心使用抗凝剂是安全且有效的。
吉林大学第一医院肝病科 刘素英 摘译
Portal vein thrombosis in patients with end stage liver disease awaiting liver transplantation: outcome ofanticoagulation
Abstract
BACKGROUND:
The prevalence of portal vein thrombosis (PVT) increases with the severity of liver disease. Development of PVT is often accompanied by increased rate of morbidity and mortality and may affect patient candidacy for liver transplant. There is limited data regarding the role of anticoagulation therapy in patients with PVT and liver cirrhosis.
OBJECTIVES:
The aims of this study were to describe the prevalence of hypercoagulable disorders in patients with liver cirrhosis and PVT, and to describe the outcome of anticoagulation in patients with liver cirrhosis and PVT.
METHODS:
A retrospective chart review was conducted of patients with liver cirrhosis awaiting liver transplant who were diagnosed with PVT between January 2005 and November 2011.
RESULTS:
During the study period, 537 patients were evaluated for liver transplant. Sixty-nine (13 %) patients were diagnosed with portal veinthrombosis. Chronic hepatitis C was the cause of liver disease in 24/69 (35 %) patients, and hepatocellular carcinoma was present in 39 % ofpatients. In 22 patients screened for hypercoagulable disorders, hypercoagulable disorder was diagnosed in one patient (5 %). Twenty-eight (28/69)patients were treated during the study period with warfarin: PVT resolved in 11/28 (39 %), no change in 5/28 (18 %), and 12/28 (43 %) patientsshowed partial resolution of thrombus. Eight patients received liver transplant while on anticoagulation, and operative notes confirmed patency of PV in all eight patients.
CONCLUSIONS:
PVT is frequently seen in patients with end stage liver disease with prevalence of 13 %. Hypercoagulable disorder was detected in 5 % of the patients screened. Careful use of anticoagulation is safe and effective in patients with PVT.
