Факторы риска, ассоциированные с тромбозом воротной вены, у больных циррозом печени: исследование случай-контроль
Факторы риска, ассоциированные с тромбозом воротной вены, у больных циррозом печени: исследование случай-контроль
Надинская М.Ю., Кодзоева Х.Б., Ульянова К.А. и др. Факторы риска, ассоциированные с тромбозом воротной вены, у больных циррозом печени: исследование случай-контроль. Терапевтический архив. 2019; 91 (2): 8–81.
DOI: 10.26442/00403660.2019.02.000153
DOI: 10.26442/00403660.2019.02.000153
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Аннотация
Тромбоз воротной вены (ТВВ) у больных циррозом печени (ЦП) – частое осложнение, ассоциированное с развитием неблагоприятных исходов.
Цель исследования – построить предиктивную модель ТВВ у больных ЦП.
Материалы и методы. Проведено одноцентровое исследование случай-контроль. Из базы данных 1512 больных ЦП в группу «Случай» включено 94 пациента с впервые диагностированным ТВВ на основании данных мультиспиральной компьютерной томографии с контрастным усилением. Критерий исключения – опухолевый ТВВ. Группа «Контроль» подобрана из больных без ТВВ методом стратифицированной рандомизации по полу, возрасту и этиологии ЦП; отношение случай-контроль составило 1 : 3–4. Оценена частота ТВВ в общей базе данных, клинические, лабораторные и инструментальные параметры в группах. Для оценки ассоциации между переменными и ТВВ использовалась модель логистической регрессии.
Результаты и обсуждение. Общая частота ТВВ составила 6,2%, с наибольшими значениями среди пациентов с HBV-инфекцией – 16,7%, неалкогольным стеатогепатитом – 15,6%, злоупотреблением алкоголем в сочетании с HCV инфекцией – 11,7%. Лучшая предиктивная модель включала в себя следующие переменные: Child-Pugh классов B–C (коэффициент регрессии β=1,853, р=0,001), асцит (β=0,460, р=0,003), не инвазирующий сосуды гепатоцеллюлярный рак (β=2,126, р=0,0001), эндоскопическое лигирование (β=0,774, р=0,003), азигопортальное разобщение (β=2,734, р=0,001), портальную гипертензионную гастропатию (β=0,793, р=0,017), диаметр воротной вены (β=0,203, р=0,004), локальные факторы – обострение неспецифического язвенного колита, энтероколит, вызванный Clostridium difficile, спонтанный бактериальный перитонит, колоректальный рак, спленэктомию, холецистэктомию (β=2,075, р=0,017). Точность модели составила 85,8% (95% ДИ 81,7–89,4%), чувствительность – 55,1% (95% ДИ 43,4–66,4%), специфичность – 95% (95% ДИ 91,6–97,3%), площадь под кривой – 0,871 (95% ДИ 0,826–0,916).
Заключение. Тяжесть ЦП классов В–С по Child-Рugh, выраженная портальная гипертензия, гепатоцеллюлярный рак, не инвазирующий сосуды, и локальные факторы установлены как предикторы ТВВ у больных ЦП.
Ключевые слова: тромбоз воротной вены, цирроз печени, исследование случай-контроль, класс по Child-Pugh, портальная гипертензия, гепатоцеллюлярный рак, локальные факторы, модель логистической регрессии.
Aim. To build a predictive model for PVT in cirrhotic patients.
Materials and methods. A single centre case-control study was carried out. From the database of 1512 cirrhotic patients 94 with newly diagnosed PVT based on contrast-enhanced computed tomography were referred to the Case group. Malignant PVT was an exclusion criterion. Patients without PVT were stratified and matched according to sex, age and etiology of cirrhosis; case-control ratio was 1 : 3–4. The prevalence of PVT in the database, clinical, laboratory, instrumental parameters of the groups were evaluated. Logistic regression model was used to estimate association between variables and PVT.
Results and discussion. The overall prevalence of PVT was 6.2% with the highest rates among the patients with HBV infection – 16.7%, nonalcoholic steatohepatitis – 15.6%, alcohol abuse in combination with HCV infection – 11.7%. The best predictive model included variables: Child-Pugh classes B–C (coefficient of regression β=1.853, р=0.001), ascites (β=0.460, р=0.003), hepatocellular carcinoma without vascular invasion (β=2.126, р=0.0001), endoscopic band ligation (β=0.774, р=0.003), azygoportal disconnection (β=2.734, р=0.001), portal hypertensive gastropathy (β=0.793, р=0.017), portal vein diameter (β=0.203, р=0.004), and local factors – ulcerative colitis flare, Clostridium difficile enterocolitis, spontaneous bacterial peritonitis, colorectal cancer, splenectomy, cholecystectomy (β=2.075, р=0.017). The model had accuracy 85.8% (95% CI 81.7–89.4%), sensitivity – 55.1% (95% CI 43.4–66.4%), specificity – 95% (95% CI 91.6–97.3%), and AUC – 0.871 (95% CI 0.826–0.916).
Conclusion. Child-Pugh classes B–C, severe portal hypertension, hepatocellular carcinoma without vascular invasion, and local factors were estimated as risk factors of PVT in cirrhotic patients.
Keywords: portal vein thrombosis, liver cirrhosis, case-control study, Child-Pugh class, portal hypertension, hepatocellular carcinoma, local factors, logistic regression model.
Цель исследования – построить предиктивную модель ТВВ у больных ЦП.
Материалы и методы. Проведено одноцентровое исследование случай-контроль. Из базы данных 1512 больных ЦП в группу «Случай» включено 94 пациента с впервые диагностированным ТВВ на основании данных мультиспиральной компьютерной томографии с контрастным усилением. Критерий исключения – опухолевый ТВВ. Группа «Контроль» подобрана из больных без ТВВ методом стратифицированной рандомизации по полу, возрасту и этиологии ЦП; отношение случай-контроль составило 1 : 3–4. Оценена частота ТВВ в общей базе данных, клинические, лабораторные и инструментальные параметры в группах. Для оценки ассоциации между переменными и ТВВ использовалась модель логистической регрессии.
Результаты и обсуждение. Общая частота ТВВ составила 6,2%, с наибольшими значениями среди пациентов с HBV-инфекцией – 16,7%, неалкогольным стеатогепатитом – 15,6%, злоупотреблением алкоголем в сочетании с HCV инфекцией – 11,7%. Лучшая предиктивная модель включала в себя следующие переменные: Child-Pugh классов B–C (коэффициент регрессии β=1,853, р=0,001), асцит (β=0,460, р=0,003), не инвазирующий сосуды гепатоцеллюлярный рак (β=2,126, р=0,0001), эндоскопическое лигирование (β=0,774, р=0,003), азигопортальное разобщение (β=2,734, р=0,001), портальную гипертензионную гастропатию (β=0,793, р=0,017), диаметр воротной вены (β=0,203, р=0,004), локальные факторы – обострение неспецифического язвенного колита, энтероколит, вызванный Clostridium difficile, спонтанный бактериальный перитонит, колоректальный рак, спленэктомию, холецистэктомию (β=2,075, р=0,017). Точность модели составила 85,8% (95% ДИ 81,7–89,4%), чувствительность – 55,1% (95% ДИ 43,4–66,4%), специфичность – 95% (95% ДИ 91,6–97,3%), площадь под кривой – 0,871 (95% ДИ 0,826–0,916).
Заключение. Тяжесть ЦП классов В–С по Child-Рugh, выраженная портальная гипертензия, гепатоцеллюлярный рак, не инвазирующий сосуды, и локальные факторы установлены как предикторы ТВВ у больных ЦП.
Ключевые слова: тромбоз воротной вены, цирроз печени, исследование случай-контроль, класс по Child-Pugh, портальная гипертензия, гепатоцеллюлярный рак, локальные факторы, модель логистической регрессии.
________________________________________________
Aim. To build a predictive model for PVT in cirrhotic patients.
Materials and methods. A single centre case-control study was carried out. From the database of 1512 cirrhotic patients 94 with newly diagnosed PVT based on contrast-enhanced computed tomography were referred to the Case group. Malignant PVT was an exclusion criterion. Patients without PVT were stratified and matched according to sex, age and etiology of cirrhosis; case-control ratio was 1 : 3–4. The prevalence of PVT in the database, clinical, laboratory, instrumental parameters of the groups were evaluated. Logistic regression model was used to estimate association between variables and PVT.
Results and discussion. The overall prevalence of PVT was 6.2% with the highest rates among the patients with HBV infection – 16.7%, nonalcoholic steatohepatitis – 15.6%, alcohol abuse in combination with HCV infection – 11.7%. The best predictive model included variables: Child-Pugh classes B–C (coefficient of regression β=1.853, р=0.001), ascites (β=0.460, р=0.003), hepatocellular carcinoma without vascular invasion (β=2.126, р=0.0001), endoscopic band ligation (β=0.774, р=0.003), azygoportal disconnection (β=2.734, р=0.001), portal hypertensive gastropathy (β=0.793, р=0.017), portal vein diameter (β=0.203, р=0.004), and local factors – ulcerative colitis flare, Clostridium difficile enterocolitis, spontaneous bacterial peritonitis, colorectal cancer, splenectomy, cholecystectomy (β=2.075, р=0.017). The model had accuracy 85.8% (95% CI 81.7–89.4%), sensitivity – 55.1% (95% CI 43.4–66.4%), specificity – 95% (95% CI 91.6–97.3%), and AUC – 0.871 (95% CI 0.826–0.916).
Conclusion. Child-Pugh classes B–C, severe portal hypertension, hepatocellular carcinoma without vascular invasion, and local factors were estimated as risk factors of PVT in cirrhotic patients.
Keywords: portal vein thrombosis, liver cirrhosis, case-control study, Child-Pugh class, portal hypertension, hepatocellular carcinoma, local factors, logistic regression model.
Список литературы
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5. Tripodi A. Hemostasis in acute and chronic liver disease. Semin Liver Dis. 2017;37(1):28-32. doi: 10.1055/s-0036-1597770
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20. Merchante N, Rivero-Juárez A, Téllez F, et al. Liver stiffness predicts variceal bleeding in HIV/HCV-coinfected patients with compensated cirrhosis. AIDS. 2017;31(4):493-500. doi: 10.1097/QAD.0000000000001358
21. Huang L, Yu Q, Wang J. Association between changes in splanchnic hemodynamics and risk factors of portal venous system thrombosis after splenectomy with periesophagogastric devascularization. Med Sci Monit. 2018;24:4355-62. doi: 10.12659/MSM.909403
22. Piscaglia F, Gianstefani A, Ravaioli M, et al. Criteria for diagnosing benign portal vein thrombosis in the assessment of patients with cirrhosis and hepatocellular carcinoma for liver transplantation. Liver Transplant. 2010;16(5):658-67. doi: 10.1002/lt.22044
23. Arab JP, Martin-Mateos RM, Shah VH. Gut – liver axis, cirrhosis and portal hypertension: the chicken and the egg. Hepatol Int. 2018;12(S1):24-33. doi: 10.1007/s12072-017-9798-x
24. Carnevale R, Raparelli V, Nocella C, et al. Gut-derived endotoxin stimulates factor VIII secretion from endothelial cells. Implications for hypercoagulability in cirrhosis. J Hepatol. 2017;67(5):950-6. doi: 10.1016/j.jhep.2017.07.002
25. Azzawi YAl, Abboodi YAl, Fasullo M, Kheder J. Risk factors stratifications for portal venous thrombosis (PVT). J Liver. 2017;6(2):2-4. doi: 10.4172/2167-0889.1000208
26. Kurniawan A, Pratama HLN. Clostridium difficile infection is risk factor of portal vein thrombosis in hepatocellular carcinoma patients. Thromb Res. 2018;164:S215. doi: 10.1016/j.thromres.2018.02.076
27. Moreau N, Wittebole X, Fleury Y, et al. Neutrophil-to-lymphocyte ratio predicts death in acute-on-chronic liver failure patients admitted to the intensive care unit. Shock. 2018;49(4):385-92. doi: 10.1097/SHK.0000000000000993
28. Sadequl ASSI, Rashid M, Alam M, et al. Thrombocytosis: a paraneoplastic syndrome in patients with hepatitis B related hepatocellular carcinoma. Gastroenterol Hepatol Int J. 2017;2(2):1-6. doi: 10.23880/GHIJ-16000121
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2. Balfour GW, Stewart G. Case of enlarged spleen complicated with ascites, both depending upon varicose dilatation and thrombosis of the portal vein. J Med Edinburgh. 1869;14(7):589-99. PMID: 29639641.
3. Rajani R, Björnsson E, Bergquist A, et al. The epidemiology and clinical features of portal vein thrombosis: a multicentre study. Aliment Pharmacol Ther. 2010;32(9):1154-62. doi: 10.1111/j.1365-2036.2010.04454.x
4. Sarin SK, Philips CA, Kamath PS, et al. Toward a comprehensive new classification of portal vein thrombosis in patients with cirrhosis. Gastroenterology. 2016;151(4):574-77.e3. doi: 10.1053/j.gastro.2016.08.033
5. Tripodi A. Hemostasis in acute and chronic liver disease. Semin Liver Dis. 2017;37(1):28-32. doi: 10.1055/s-0036-1597770
6. Cool J, Rosenblatt R, Kumar S, et al. Portal vein thrombosis prevalence and associated mortality in cirrhosis in a nationally representative inpatient cohort. J Gastroenterol Hepatol. 2018;11(10). doi: 10.1111/jgh.14501 [Epub ahead of print].
7. Amitrano L, Guardascione MA, Brancaccio V, et al. Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. J Hepatol. 2004;40(5):736-41. doi: 10.1016/j.jhep.2004.01.001
8. Ghabril M, Agarwal S, Lacerda M, et al. Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation. Transplantation. 2016;100(1):126-33. doi: 10.1097/TP.0000000000000785
9. De Franchis R, Abraldes JG, Bajaj J, et al. Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63:743-52. doi: 10.1016/j.jhep.2015.07.001
10. Stine JG, Wang J, Shah PM, et al. Decreased portal vein velocity is predictive of the development of portal vein thrombosis: a matched case-control study. Liver Int. 2018;38(1):94-101. doi: 10.1111/liv.13500
11. Lankarani KB, Homayon K, Motevalli D, et al. Risk factors for portal vein thrombosis in patients with cirrhosis awaiting liver transplantation in Shiraz, Iran. Hepat Mon. 2015;15(12):2-5. doi: 10.5812/hepatmon.26407
12. Mangia A, Villani MR, Cappucci G, et al. Causes of portal venous thrombosis in cirrhotic patients: the role of genetic and acquired factors. Eur J Gastroenterol Hepatol. 2005;17(7):745-51. PMID: 15947552.
13. EASL clinical practice guidelines: vascular diseases of the liver. J Hepatol. 2016;64(1):179-202. doi: 10.1016/j.jhep.2015.07.040
14. Ivashkin VT, Mayevskaya MV, Pavlov ChS, et al. Treatment of liver cirrhosis complications: clinical guidelines of the Russian scientific liver society and Russian gastroenterological association. Rossiyskiy Zhurnal Gastroenterologii, Gepatologii, Koloproktologii. 2016;26(4):71-102 (In Russ.)
15. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406-60. doi: 10.1016/j.jhep.2018.03.024
16. Russian Society of Surgeons [Electronic resource]. Clinical practice guidelines on the management of esophageal and gastric variceal bleeding. 2014. P.9. URL: http://общество-хирургов.рф/upload/gkk_iz_vven.doc, free (accessed 30.08.2018) (In Russ.)
17. Leonov VP. Logistic regression in medicine and biology. [Electronic resource]. URL: http://www.biometrica.tomsk.ru/logit_1.htm – http://www.biometrica.tomsk.ru/logit_8.htm, free (accessed 25.02. 2018) (In Russ.)
18. Stine JG, Shah NL, Argo CK, et al. Increased risk of portal vein thrombosis in patients with cirrhosis due to nonalcoholic steatohepatitis. Liver Transplant. 2015;21(8):1016-21. doi: 10.1002/lt.24134
19. Nonami T, Yokoyama I, Iwatsuki S, Starzl TE. The incidence of portal vein thrombosis at liver transplantation. Hepatology. 1992;16(5):1195-8. doi: 10.1016/0270-9139(92)90014-Z
20. Merchante N, Rivero-Juárez A, Téllez F, et al. Liver stiffness predicts variceal bleeding in HIV/HCV-coinfected patients with compensated cirrhosis. AIDS. 2017;31(4):493-500. doi: 10.1097/QAD.0000000000001358
21. Huang L, Yu Q, Wang J. Association between changes in splanchnic hemodynamics and risk factors of portal venous system thrombosis after splenectomy with periesophagogastric devascularization. Med Sci Monit. 2018;24:4355-62. doi: 10.12659/MSM.909403
22. Piscaglia F, Gianstefani A, Ravaioli M, et al. Criteria for diagnosing benign portal vein thrombosis in the assessment of patients with cirrhosis and hepatocellular carcinoma for liver transplantation. Liver Transplant. 2010;16(5):658-67. doi: 10.1002/lt.22044
23. Arab JP, Martin-Mateos RM, Shah VH. Gut – liver axis, cirrhosis and portal hypertension: the chicken and the egg. Hepatol Int. 2018;12(S1):24-33. doi: 10.1007/s12072-017-9798-x
24. Carnevale R, Raparelli V, Nocella C, et al. Gut-derived endotoxin stimulates factor VIII secretion from endothelial cells. Implications for hypercoagulability in cirrhosis. J Hepatol. 2017;67(5):950-6. doi: 10.1016/j.jhep.2017.07.002
25. Azzawi YAl, Abboodi YAl, Fasullo M, Kheder J. Risk factors stratifications for portal venous thrombosis (PVT). J Liver. 2017;6(2):2-4. doi: 10.4172/2167-0889.1000208
26. Kurniawan A, Pratama HLN. Clostridium difficile infection is risk factor of portal vein thrombosis in hepatocellular carcinoma patients. Thromb Res. 2018;164:S215. doi: 10.1016/j.thromres.2018.02.076
27. Moreau N, Wittebole X, Fleury Y, et al. Neutrophil-to-lymphocyte ratio predicts death in acute-on-chronic liver failure patients admitted to the intensive care unit. Shock. 2018;49(4):385-92. doi: 10.1097/SHK.0000000000000993
28. Sadequl ASSI, Rashid M, Alam M, et al. Thrombocytosis: a paraneoplastic syndrome in patients with hepatitis B related hepatocellular carcinoma. Gastroenterol Hepatol Int J. 2017;2(2):1-6. doi: 10.23880/GHIJ-16000121
29. Li Y, Qi X, Li H, et al. D-dimer level for predicting the in-hospital mortality in liver cirrhosis: a retrospective study. Exp Ther Med. 2017;13(1):285-9. doi: 10.3892/etm.2016.3930
30. Fletcher RH, Fletcher SW, Wagner EH. Clinical epidemiology: the essentials. 3rd ed. Williams & Wilkins; 1996. Р. 219].
2. Balfour GW, Stewart G. Case of enlarged spleen complicated with ascites, both depending upon varicose dilatation and thrombosis of the portal vein. J Med Edinburgh. 1869;14(7):589-99. PMID: 29639641.
3. Rajani R, Björnsson E, Bergquist A, et al. The epidemiology and clinical features of portal vein thrombosis: a multicentre study. Aliment Pharmacol Ther. 2010;32(9):1154-62. doi: 10.1111/j.1365-2036.2010.04454.x
4. Sarin SK, Philips CA, Kamath PS, et al. Toward a comprehensive new classification of portal vein thrombosis in patients with cirrhosis. Gastroenterology. 2016;151(4):574-77.e3. doi: 10.1053/j.gastro.2016.08.033
5. Tripodi A. Hemostasis in acute and chronic liver disease. Semin Liver Dis. 2017;37(1):28-32. doi: 10.1055/s-0036-1597770
6. Cool J, Rosenblatt R, Kumar S, et al. Portal vein thrombosis prevalence and associated mortality in cirrhosis in a nationally representative inpatient cohort. J Gastroenterol Hepatol. 2018;11(10). doi: 10.1111/jgh.14501 [Epub ahead of print].
7. Amitrano L, Guardascione MA, Brancaccio V, et al. Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. J Hepatol. 2004;40(5):736-41. doi: 10.1016/j.jhep.2004.01.001
8. Ghabril M, Agarwal S, Lacerda M, et al. Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation. Transplantation. 2016;100(1):126-33. doi: 10.1097/TP.0000000000000785
9. De Franchis R, Abraldes JG, Bajaj J, et al. Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63:743-52. doi: 10.1016/j.jhep.2015.07.001
10. Stine JG, Wang J, Shah PM, et al. Decreased portal vein velocity is predictive of the development of portal vein thrombosis: a matched case-control study. Liver Int. 2018;38(1):94-101. doi: 10.1111/liv.13500
11. Lankarani KB, Homayon K, Motevalli D, et al. Risk factors for portal vein thrombosis in patients with cirrhosis awaiting liver transplantation in Shiraz, Iran. Hepat Mon. 2015;15(12):2-5. doi: 10.5812/hepatmon.26407
12. Mangia A, Villani MR, Cappucci G, et al. Causes of portal venous thrombosis in cirrhotic patients: the role of genetic and acquired factors. Eur J Gastroenterol Hepatol. 2005;17(7):745-51. PMID: 15947552.
13. EASL clinical practice guidelines: vascular diseases of the liver. J Hepatol. 2016;64(1):179-202. doi: 10.1016/j.jhep.2015.07.040
14. Ивашкин В.Т., Маевская М.В., Павлов Ч.С. и др. Клинические рекомендации Российского общества по изучению печени и Российской гастроэнтерологической ассоциации по лечению осложнений цирроза печени. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2016;26(4):71-102 [Ivashkin VT, Mayevskaya MV, Pavlov ChS, et al. Treatment of liver cirrhosis complications: clinical guidelines of the Russian scientific liver society and Russian gastroenterological association. Rossiyskiy Zhurnal Gastroenterologii, Gepatologii, Koloproktologii. 2016;26(4):71-102 (In Russ.)].
15. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406-60. doi: 10.1016/j.jhep.2018.03.024
16. Российское общество хирургов. [Электронный ресурс]. Клинические рекомендации по лечению кровотечений из варикозно расширенных вен пищевода и желудка. 2014. С.9. Режим доступа: http://общество-хирургов.рф/upload/gkk_iz_vven.doc, свободный. Дата обращения 30.08.2018 [Russian Society of Surgeons [Electronic resource]. Clinical practice guidelines on the management of esophageal and gastric variceal bleeding. 2014. P.9. URL: http://общество-хирургов.рф/upload/gkk_iz_vven.doc, free (accessed 30.08.2018) (In Russ.)].
17. Леонов В.П. Логистическая регрессия в медицине и биологии [Электронный ресурс]. Режим доступа: http://www.biometrica.tomsk.ru/logit_1.htm – http://www.biometrica.tomsk.ru/logit_8.htm, свободный. Дата обращения: 25.02.2018 [Leonov VP. Logistic regression in medicine and biology. [Electronic resource]. URL: http://www.biometrica.tomsk.ru/logit_1.htm – http://www.biometrica.tomsk.ru/logit_8.htm, free (accessed 25.02. 2018) (In Russ.)].
18. Stine JG, Shah NL, Argo CK, et al. Increased risk of portal vein thrombosis in patients with cirrhosis due to nonalcoholic steatohepatitis. Liver Transplant. 2015;21(8):1016-21. doi: 10.1002/lt.24134
19. Nonami T, Yokoyama I, Iwatsuki S, Starzl TE. The incidence of portal vein thrombosis at liver transplantation. Hepatology. 1992;16(5):1195-8. doi: 10.1016/0270-9139(92)90014-Z
20. Merchante N, Rivero-Juárez A, Téllez F, et al. Liver stiffness predicts variceal bleeding in HIV/HCV-coinfected patients with compensated cirrhosis. AIDS. 2017;31(4):493-500. doi: 10.1097/QAD.0000000000001358
21. Huang L, Yu Q, Wang J. Association between changes in splanchnic hemodynamics and risk factors of portal venous system thrombosis after splenectomy with periesophagogastric devascularization. Med Sci Monit. 2018;24:4355-62. doi: 10.12659/MSM.909403
22. Piscaglia F, Gianstefani A, Ravaioli M, et al. Criteria for diagnosing benign portal vein thrombosis in the assessment of patients with cirrhosis and hepatocellular carcinoma for liver transplantation. Liver Transplant. 2010;16(5):658-67. doi: 10.1002/lt.22044
23. Arab JP, Martin-Mateos RM, Shah VH. Gut – liver axis, cirrhosis and portal hypertension: the chicken and the egg. Hepatol Int. 2018;12(S1):24-33. doi: 10.1007/s12072-017-9798-x
24. Carnevale R, Raparelli V, Nocella C, et al. Gut-derived endotoxin stimulates factor VIII secretion from endothelial cells. Implications for hypercoagulability in cirrhosis. J Hepatol. 2017;67(5):950-6. doi: 10.1016/j.jhep.2017.07.002
25. Azzawi YAl, Abboodi YAl, Fasullo M, Kheder J. Risk factors stratifications for portal venous thrombosis (PVT). J Liver. 2017;6(2):2-4. doi: 10.4172/2167-0889.1000208
26. Kurniawan A, Pratama HLN. Clostridium difficile infection is risk factor of portal vein thrombosis in hepatocellular carcinoma patients. Thromb Res. 2018;164:S215. doi: 10.1016/j.thromres.2018.02.076
27. Moreau N, Wittebole X, Fleury Y, et al. Neutrophil-to-lymphocyte ratio predicts death in acute-on-chronic liver failure patients admitted to the intensive care unit. Shock. 2018;49(4):385-92. doi: 10.1097/SHK.0000000000000993
28. Sadequl ASSI, Rashid M, Alam M, et al. Thrombocytosis: a paraneoplastic syndrome in patients with hepatitis B related hepatocellular carcinoma. Gastroenterol Hepatol Int J. 2017;2(2):1-6. doi: 10.23880/GHIJ-16000121
29. Li Y, Qi X, Li H, et al. D-dimer level for predicting the in-hospital mortality in liver cirrhosis: a retrospective study. Exp Ther Med. 2017;13(1):285-9. doi: 10.3892/etm.2016.3930
30. Флетчер Р, Флетчер С, Вагнер Э. Клиническая эпидемиология. Основы доказательной медицины. Пер. с англ. 3-е изд. М.: Медиа Сфера; 2004. С. 268 [Fletcher RH, Fletcher SW, Wagner EH. Clinical epidemiology: the essentials. 3rd ed. Williams & Wilkins; 1996. Р. 219].
________________________________________________
2. Balfour GW, Stewart G. Case of enlarged spleen complicated with ascites, both depending upon varicose dilatation and thrombosis of the portal vein. J Med Edinburgh. 1869;14(7):589-99. PMID: 29639641.
3. Rajani R, Björnsson E, Bergquist A, et al. The epidemiology and clinical features of portal vein thrombosis: a multicentre study. Aliment Pharmacol Ther. 2010;32(9):1154-62. doi: 10.1111/j.1365-2036.2010.04454.x
4. Sarin SK, Philips CA, Kamath PS, et al. Toward a comprehensive new classification of portal vein thrombosis in patients with cirrhosis. Gastroenterology. 2016;151(4):574-77.e3. doi: 10.1053/j.gastro.2016.08.033
5. Tripodi A. Hemostasis in acute and chronic liver disease. Semin Liver Dis. 2017;37(1):28-32. doi: 10.1055/s-0036-1597770
6. Cool J, Rosenblatt R, Kumar S, et al. Portal vein thrombosis prevalence and associated mortality in cirrhosis in a nationally representative inpatient cohort. J Gastroenterol Hepatol. 2018;11(10). doi: 10.1111/jgh.14501 [Epub ahead of print].
7. Amitrano L, Guardascione MA, Brancaccio V, et al. Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. J Hepatol. 2004;40(5):736-41. doi: 10.1016/j.jhep.2004.01.001
8. Ghabril M, Agarwal S, Lacerda M, et al. Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation. Transplantation. 2016;100(1):126-33. doi: 10.1097/TP.0000000000000785
9. De Franchis R, Abraldes JG, Bajaj J, et al. Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63:743-52. doi: 10.1016/j.jhep.2015.07.001
10. Stine JG, Wang J, Shah PM, et al. Decreased portal vein velocity is predictive of the development of portal vein thrombosis: a matched case-control study. Liver Int. 2018;38(1):94-101. doi: 10.1111/liv.13500
11. Lankarani KB, Homayon K, Motevalli D, et al. Risk factors for portal vein thrombosis in patients with cirrhosis awaiting liver transplantation in Shiraz, Iran. Hepat Mon. 2015;15(12):2-5. doi: 10.5812/hepatmon.26407
12. Mangia A, Villani MR, Cappucci G, et al. Causes of portal venous thrombosis in cirrhotic patients: the role of genetic and acquired factors. Eur J Gastroenterol Hepatol. 2005;17(7):745-51. PMID: 15947552.
13. EASL clinical practice guidelines: vascular diseases of the liver. J Hepatol. 2016;64(1):179-202. doi: 10.1016/j.jhep.2015.07.040
14. Ivashkin VT, Mayevskaya MV, Pavlov ChS, et al. Treatment of liver cirrhosis complications: clinical guidelines of the Russian scientific liver society and Russian gastroenterological association. Rossiyskiy Zhurnal Gastroenterologii, Gepatologii, Koloproktologii. 2016;26(4):71-102 (In Russ.)
15. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406-60. doi: 10.1016/j.jhep.2018.03.024
16. Russian Society of Surgeons [Electronic resource]. Clinical practice guidelines on the management of esophageal and gastric variceal bleeding. 2014. P.9. URL: http://общество-хирургов.рф/upload/gkk_iz_vven.doc, free (accessed 30.08.2018) (In Russ.)
17. Leonov VP. Logistic regression in medicine and biology. [Electronic resource]. URL: http://www.biometrica.tomsk.ru/logit_1.htm – http://www.biometrica.tomsk.ru/logit_8.htm, free (accessed 25.02. 2018) (In Russ.)
18. Stine JG, Shah NL, Argo CK, et al. Increased risk of portal vein thrombosis in patients with cirrhosis due to nonalcoholic steatohepatitis. Liver Transplant. 2015;21(8):1016-21. doi: 10.1002/lt.24134
19. Nonami T, Yokoyama I, Iwatsuki S, Starzl TE. The incidence of portal vein thrombosis at liver transplantation. Hepatology. 1992;16(5):1195-8. doi: 10.1016/0270-9139(92)90014-Z
20. Merchante N, Rivero-Juárez A, Téllez F, et al. Liver stiffness predicts variceal bleeding in HIV/HCV-coinfected patients with compensated cirrhosis. AIDS. 2017;31(4):493-500. doi: 10.1097/QAD.0000000000001358
21. Huang L, Yu Q, Wang J. Association between changes in splanchnic hemodynamics and risk factors of portal venous system thrombosis after splenectomy with periesophagogastric devascularization. Med Sci Monit. 2018;24:4355-62. doi: 10.12659/MSM.909403
22. Piscaglia F, Gianstefani A, Ravaioli M, et al. Criteria for diagnosing benign portal vein thrombosis in the assessment of patients with cirrhosis and hepatocellular carcinoma for liver transplantation. Liver Transplant. 2010;16(5):658-67. doi: 10.1002/lt.22044
23. Arab JP, Martin-Mateos RM, Shah VH. Gut – liver axis, cirrhosis and portal hypertension: the chicken and the egg. Hepatol Int. 2018;12(S1):24-33. doi: 10.1007/s12072-017-9798-x
24. Carnevale R, Raparelli V, Nocella C, et al. Gut-derived endotoxin stimulates factor VIII secretion from endothelial cells. Implications for hypercoagulability in cirrhosis. J Hepatol. 2017;67(5):950-6. doi: 10.1016/j.jhep.2017.07.002
25. Azzawi YAl, Abboodi YAl, Fasullo M, Kheder J. Risk factors stratifications for portal venous thrombosis (PVT). J Liver. 2017;6(2):2-4. doi: 10.4172/2167-0889.1000208
26. Kurniawan A, Pratama HLN. Clostridium difficile infection is risk factor of portal vein thrombosis in hepatocellular carcinoma patients. Thromb Res. 2018;164:S215. doi: 10.1016/j.thromres.2018.02.076
27. Moreau N, Wittebole X, Fleury Y, et al. Neutrophil-to-lymphocyte ratio predicts death in acute-on-chronic liver failure patients admitted to the intensive care unit. Shock. 2018;49(4):385-92. doi: 10.1097/SHK.0000000000000993
28. Sadequl ASSI, Rashid M, Alam M, et al. Thrombocytosis: a paraneoplastic syndrome in patients with hepatitis B related hepatocellular carcinoma. Gastroenterol Hepatol Int J. 2017;2(2):1-6. doi: 10.23880/GHIJ-16000121
29. Li Y, Qi X, Li H, et al. D-dimer level for predicting the in-hospital mortality in liver cirrhosis: a retrospective study. Exp Ther Med. 2017;13(1):285-9. doi: 10.3892/etm.2016.3930
30. Fletcher RH, Fletcher SW, Wagner EH. Clinical epidemiology: the essentials. 3rd ed. Williams & Wilkins; 1996. Р. 219].
Авторы
М.Ю. Надинская, Х.Б. Кодзоева, К.А. Ульянова, А.С. Волкова, С.И. Рогачева, А.С. Деханов, Д.А. Стрелкова, В.Т. Ивашкин
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
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I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
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