gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2023-33-2-45-59gastro-j-879Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESФакторы риска тромбоза воротной вены у пациентов с циррозом печени разных классов по Child-PughRisk Factors of Portal Vein Thrombosis in Patients with Different Child-Pugh Classes Liver Cirrhosishttps://orcid.org/0000-0002-1210-2528НадинскаяМ. Ю.NadinskaiaM. Yu.

Надинская Мария Юрьевна — кандидат медицинских наук, доцент кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Maria Yu. Nadinskaia — Cand. Sci. (Med.), Assoc. Prof., Department of Propaedeutics of Internal Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University).

119991, Moscow, Trubetskaya str., 8/2

nadinskaya_m_yu@staff.sechenov.ruhttps://orcid.org/0000-0001-7510-6553КодзоеваХ. Б.KodzoevaKh. B.

Кодзоева Хава Багаудиновна — аспирант кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии ФГАОУ ВО «ПМГМУ им. И.М. Сеченова» (Сеченовский Университет) МЗ РФ; врач-терапевт терапевтического отделения ФГБУ «НИМЦ трансплантологии и искусственных органов им. ак. В.И. Шумакова» МЗ РФ.

119991, Москва, ул. Трубецкая, д. 8, стр. 2; 123182, Москва, Щукинская ул., д. 1

Khava B. Kodzoeva — postgraduate student, Department of Propaedeutics of Internal Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University); internist, Department of Internal Medicine, V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs.

119991, Moscow, Trubetskaya str., 8/2; 123182, Moscow, Schukinskaya str., 1

kod_eva@bk.ruhttps://orcid.org/0000-0002-3462-0123ГуляеваК. А.GulyaevaK. A.

Гуляева Ксения Александровна — аспирант кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Kseniya A. Gulyaeva — postgraduate student, Department of Propaedeutics of Internal Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University).

119991, Moscow, Trubetskaya str., 8/2

xen59@mail.ruhttps://orcid.org/0009-0000-9275-2733ХэнМ.-Д. Э.KhenM.-D. E.

Хэн Мария-Дорис Эмильевна — студентка Института клинической медицины им. Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Mariia-Doris E. Khen — student, N.V. Sklifosovskiy Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University).

119991, Moscow, Trubetskaya str., 8/2

khen-mariya@mail.ruhttps://orcid.org/0009-0001-9978-1518КоролеваД. И.KorolevaD. I.

Королева Диана Ивановна — студентка Института клинической медицины им. Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Diana I. Koroleva — student, N.V. Sklifosovskiy Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University).

119991, Moscow, Trubetskaya str., 8/2

DNAKoroleva@mail.ruhttps://orcid.org/0000-0002-6836-4228ПриваловМ. А.PrivalovM. A.

Привалов Максим Александрович — студент Института клинической медицины им. Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Maxim A. Privalov — student, N.V. Sklifosovskiy Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University).

119991, Moscow, Trubetskaya str., 8/2

makspr24@gmail.comhttps://orcid.org/0009-0005-9439-4737ТекаеваА. Х.TekaevaA. Kh.

Текаева Амина Хусаиновна — студентка Института клинической медицины им. Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Amina Kh. Tekaeva — student, N.V. Sklifosovskiy Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University).

119991, Moscow, Trubetskaya str., 8/2

aminatek@bk.ruhttps://orcid.org/0009-0005-0442-2061ФедоровВ. Р.FedorovV. R.

Федоров Владислав Романович — студент Института клинической медицины им. Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Vladislav R. Fedorov — student, N.V. Sklifosovskiy Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University).

119991, Moscow, Trubetskaya str., 8/2

fedorov02vla@gmail.comhttps://orcid.org/0009-0002-1151-7462ПрокофьевС. Г.ProkofevS. G.

Прокофьев Сергей Геннадьевич — студент Института клинической медицины им. Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Sergey G. Prokofev — student, N.V. Sklifosovskiy Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University).

119991, Moscow, Trubetskaya str., 8/2

prokofev_s_g@student.sechenov.ruФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» (Сеченовский университет) Министерства здравоохранения Российской ФедерацииРоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» (Сеченовский университет) Министерства здравоохранения Российской Федерации; ФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов им. академика В.И. Шумакова» Министерства здравоохранения Российской ФедерацииРоссияI.M. Sechenov First Moscow State Medical University (Sechenov University); V.I. Shumakov National Medical Research Center of Transplantology and Artificial OrgansRussian Federation2023280420233324559Copyright © Надинская М.Ю., Кодзоева Х.Б., Гуляева К.А., Хэн М.Э., Королева Д.И., Привалов М.А., Текаева А.Х., Федоров В.Р., Прокофьев С.Г., 20232023Надинская М.Ю., Кодзоева Х.Б., Гуляева К.А., Хэн М.Э., Королева Д.И., Привалов М.А., Текаева А.Х., Федоров В.Р., Прокофьев С.Г.Nadinskaia M.Y., Kodzoeva K.B., Gulyaeva K.A., Khen M.E., Koroleva D.I., Privalov M.A., Tekaeva A.K., Fedorov V.R., Prokofev S.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/879Цель исследования

Цель исследования: оценить частоту тромбоза воротной вены (ТВВ) и построить предиктивные модели развития ТВВ для пациентов с циррозом печени (ЦП) классов А и В/С по Child-Pugh.

Материалы и методы

Материалы и методы. Дизайн исследования — «случай-контроль». В группу «случай» включены 130 пациентов с впервые выявленным ТВВ, не обусловленным инвазией гепатоцеллюлярным раком (ГЦР); к классу А отнесены 29, к классу В/С — 101 пациент. Из базы данных пациентов с ЦП без ТВВ с помощью стратифицированной рандомизации по полу, возрасту и этиологии отобраны для класса А — 60, для класса В/С — 205 контролей. Для сравнения групп применялся U-критерий Манна — Уитни, критерий хи-квадрат Пирсона. Вычислены отношения шансов (ОШ) и 95 % доверительные интервалы (95 % ДИ). Построены модели логистической регрессии с разделением выборки на обучающую и тестовую (0,7; 0,3). На тестовой выборке рассчитаны операционные характеристики моделей; проведен ROC-анализ, вычислена площадь под ROC-кривой — AUC.

Результаты

Результаты. Общая частота ТВВ в классе А составила 4,1 % (95 % ДИ 2,7-5,8 %), классе В/С — 10,4 % (95 % ДИ 8,5-12,5 %). Пациенты с ТВВ классов А и В/С отличались от соответствующих контролей более выраженной портальной гипертензией: частота кровотечений / числа вмешательств на варикозно-расширенных венах (ВРВ) по сравнению с контролем для класса А составила 41/45 % vs. 7/8 % (р < 0,001), класса В/С — 25,7/30,7 % vs. 16,1/16,1 % (р < 0,05), частота асцита: класс А — 24 % vs. 8 % (р < 0,05), класс В/С — 89,1 % vs. 68.3      % (р < 0,001). Точка разделения по диаметру воротной вены была одинаковой для обоих классов — 13.4       мм; по длиннику селезенки была сходной и составила для класса А — 17,5 мм, для В/С — 17,1 мм. Пациенты с ТВВ отличались от соответствующих контролей по значению нейтрофильно-лимфоцитарного индекса: класс А — 2,33 (1,82; 3,61) vs. 1,76 (1,37; 2,20), р < 0,01, класс В/С — 2,49 (1,93; 3,34) vs. 2,15 (1,49; 3,26), р < 0,05. В классе В/С наблюдалась более высокая частота впервые выявленных злокачественных опухолей — 23,8 % (прежде всего ГЦР, не инвазирующего воротную вену), по сравнению с контролем и случаями класса А — 6,3 % и 3 % (р < 0,05) соответственно. Лучшая модель для класса А включала кровотечения из ВРВ, асцит, диаметр воротной вены, абсолютное число нейтрофилов, для класса В: асцит, длинник селезенки, диаметр воротной вены, злокачественные опухоли / локальные факторы; чувствительность, специфичность, точность и AUC составили: 79,3 %, 90 %, 86,5 %, 0,897 и 73,3 %, 68,3 %, 69,9 %, 0,789 соответственно.

Выводы

Выводы. Независимо от класса ЦП по Child-Pugh основным фактором риска ТВВ является тяжелая портальная гипертензия.

Aim

Aim: to evaluate the frequency of portal vein thrombosis (PVT) and build predictive models of the development of PVT for patients with liver cirrhosis (LC) of A and B/C classes by Child-Pugh.

Materials and methods

Materials and methods. Research design is a case-control. The Case group included 130 patients with newly diagnosed PVT not caused by invasive hepatocellular carcinoma (HCC); 29 patients were assigned to class A, 101 patients were assigned to class B/C. From the database of cirrhotic patients without PVT 60 Controls for class A and 205 for B/C were selected using sratified randomization by sex, age and etiology of cirrhosis. The Mann-Whitney U-test and Pearson's chi-squared test were used to compare the groups. Odds ratios (OR) and 95 % confidence intervals (95 % CI) were calculated. Logistic regression models are constructed with the separation of the sample into training and test (0.7; 0.3). The operational characteristics of the models were calculated on the test sample; ROC analysis was carried out, the area under the ROC curve (AUC) was calculated.

Results

Results. The overall frequency of PVT was 4.1 % (95 % CI 2.7-5.8 %) in class A and 10.4 % (95 % CI 8.5-12.5 %) class B/C. Patients with class A and B/C PVT differed from the corresponding controls by more severe portal hypertension: the frequency of bleeding / number of interventions on varices compared with the control were 41/45 % vs. 7/8 % (p < 0.001) for class A and 25.7/30.7 % vs. 16.1/16.1 % (p < 0.05) for class B/C, ascites frequency was 24 % vs. 8 % (p < 0.05) for class A and 89.1 % vs. 68.3 % (p < 0.001) for class B/C. The cutoff by the portal vein diameter was the same for both classes — 13.4 mm; the spleen length was similar and amounted 17.5 mm for class A, 17.1 mm for class B/C. Patients with PVT differed from the corresponding controls by neutrophil-to-lymphocyte ratio: class A 2.33 (1.82; 3.61) vs. 1.76 (1.37; 2.20), p < 0.01, class B/C 2.49 (1.93; 3.34) vs. 2.15 (1.49; 3.26), p < 0.05. Patients of class B/C had a higher incidence of newly diagnosed malignant tumors - 23.8% (primarily HCC that does not invade the portal vein), compared with control and cases of class A - 6.3 % and 3 % (p < 0.05), respectively. The best model for class A included variceal bleeding, ascites, portal vein diameter, absolute number of neutrophils, for class B — ascites, spleen length, portal vein diameter, malignant tumors / local factors; sensitivity, specificity, accuracy and AUC were 79.3 %, 90 %, 86.5 %, 0.897 and 73.3 %, 68.3 %, 69.9 %, 0.789, respectively.

Conclusion

Conclusion. Independently of the Child-Pugh class of LC, the main risk factor for PVT is severe portal hypertension.

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The authors declare that there are no conflicts of interest present.