Portal vein thrombosis in cirrhosis is not associated with intestinal barrier disruption or increased platelet aggregability

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• 作者：Piotr Wosiewicz^a ; Michał Żorniak^a ; Marek Hartleb^a ; ^{mhartleb@sum.edu.pl} ; Kamil Barański^b ; Maciej Hartleb^a ; Magdalena Onyszczuk^a ; Joanna Pilch-Kowalczyk^c ; Sławomira Kyrcz-Krzemień^d
• 关键词：PVT ; portal vein thrombosis ; vWf ; Villebrand factor ; LPS ; bacterial lipopolysaccharides ; INR ; international normalized ratio ; CRP ; c-reactive protein ; APTT ; activated partial thromboplastin time
• 刊名：Clinics and Research in Hepatology and Gastroenterology
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：40
• 期：6
• 页码：722-729
• 全文大小：692 K
• 卷排序：40

文摘

Portal vein thrombosis (PVT) is a common complication of cirrhosis, but its pathogenesis is unclear. We tested the hypotheses that PVT is the result of platelet hyperactivity or intestinal barrier disruption.MethodsThis study included 49 patients with cirrhosis (15 females) of mixed etiology. Based on spiral computed-tomography, the patients were divided into two groups: with PVT (n = 16) and without PVT (n = 33). Serum biomarkers of intestinal barrier integrity were endotoxins and zonulin, and platelet activity was assessed with multiple electrode aggregometry.ResultsThe levels of endotoxin (43.5 ± 18.3 ng/ml vs. 36.9 ± 7.5 ng/ml; P = 0.19) and zonulin (56.3 ± 31.1 ng/ml vs. 69.3 ± 63.1 ng/ml; P = 0.69) were not different between the patients with and without PVT. Moreover, endotoxin and zonulin did not correlate with the coagulation and platelet parameters. The platelet aggregability measured with the TRAP and the ADP tests was decreased in PVT patients. In the logistic regression analysis the PVT incidence was related to the levels of D-dimer and bilirubin as well as the TRAP test results. Patients with PVT presented with significantly higher levels of D-dimer (4.45 ± 2.59 vs. 3.03 ± 2.97 mg/l; P < 0.05) and prothrombin levels (175 ± 98.8 μg/ml vs. 115 ± 72.9 μg/ml; P < 0.05) than patients without thrombosis. PVT could be excluded with a 90% negative predictive value when the D-dimer level was below 1.82 mg/l.ConclusionsEndotoxemia and platelet activity are not determinants of PVT in patients with cirrhosis. The D-dimer measurement has diagnostic significance for PVT in patients with liver cirrhosis.