Changes of iron metabolism in patients with hepatitis B cirrhosis complicated with esophageal and gastric varices and portal vein thrombosis
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目的 探究合并门静脉血栓的乙肝肝硬化伴食管胃静脉曲张患者的铁代谢特征改变.方法 本研究为横断面研究,纳入2020年1月1日至2021年12月31日在复旦大学附属中山医院住院并进行铁代谢指标检测的253例乙肝肝硬化伴食管胃静脉曲张患者,依据有无门静脉血栓分为门静脉血栓组(n=57)和不合并门静脉血栓组(n=196),比较两组铁代谢特征指标,并依据有无腹水、血小板计数水平、D-二聚体水平、Child-pugh分级进行亚组分析,并通过多因素logistic回归分析筛选与门静脉血栓相关的因素.结果 合并门静脉血栓的乙肝肝硬化伴食管胃静脉曲张患者,其Child-pugh B/C级、合并腹水的比例更高,D-二聚体水平更高,血小板计数水平更低(均P＜0.05).门静脉血栓组患者可溶性转铁蛋白受体水平更高[2.4(1.8,3.6)mg/L vs 1.8(1.3,2.7)mg/L,P=0.006],铁蛋白水平更低[33.1(18.9,63.3)ng/ml vs 57.7(19.4,142.5)ng/ml,P=0.038].分层分析显示,腹水、血小板计数水平、D-二聚体水平和Child-pugh分级,不影响铁蛋白与门静脉血栓的负相关趋势和可溶性转铁蛋白受体与门静脉血栓的正相关趋势,且可溶性转铁蛋白受体在无腹水、低D-二聚体水平、Child-pugh A级时,与门静脉血栓均呈正相关性(均P＜0.05).多因素分析提示,权衡Child-pugh分级、血小板计数、D-二聚体水平后,铁蛋白(OR=0.943,95％CI:0.904～0.983,P=0.006)、可溶性转铁蛋白受体(OR=1.034,95％CI:1.001～1.067,P=0.044)与门静脉血栓独立相关.结论 乙肝肝硬化伴食管胃静脉曲张患者中,合并门静脉血栓患者的铁代谢特征与无血栓患者存在差异,具有更高水平的可溶性转铁蛋白受体与更低水平的铁蛋白.
Objective To explore the changes of iron metabolism in patients with hepatitis B cirrhosis and esophageal and gastric varices complicated with portal vein thrombosis.Methods This study was a cross-sectional study.253 patients with hepatitis B cirrhosis with esophageal and gastric varices who were hospitalized in the Zhongshan Hospital,Fudan University from January 1,2020 to December 31,2021 were included in this study.They were divided into portal vein thrombosis group(n=57)and non portal vein thrombosis group(n=196)according to the presence or absence of portal vein thrombosis.The iron metabolism characteristics of the two groups were compared,and subgroups were analyzed according to the presence or absence of ascites,platelet count level,D-dimer level,and Child grade.The factors related to portal vein thrombosis were screened through multivariate logistic regression analysis.Results The ratio of Child pugh B/C,ascites,D-dimer and platelet count in patients with hepatitis B cirrhosis and esophageal and gastric varices complicated with portal vein thrombosis was higher(all P＜0.05).Patients with portal vein thrombosis had higher levels of soluble transferrin receptor[2.4(1.8,3.6)mg/L vs 1.8(1.3,2.7)mg/L,P=0.006],and lower levels of ferritin[33.1(18.9,63.3)ng/ml vs 57.7(19.4,142.5)ng/ml,P=0.038].Layered analysis showed that ascites,platelet count levels,D-dimer levels,and Child-pugh grade did not affect the negative correlation trend between ferritin and portal vein thrombosis,and the positive correlation trend between soluble transferrin receptors and portal vein thrombosis.Moreover,soluble transferrin receptors showed a statistically significant positive correlation with portal vein thrombosis in the absence of ascites,low D-dimer levels,and Child-pugh grade A.Multivariate analysis suggested that after weighing Child-pugh grading,platelet count,and D-dimer levels,ferritin(OR=0.943,95％CI:0.904-0.983,P=0.006)and soluble transferrin receptor(OR=1.034,95％CI:0.001-1.067,P=0.044)were independently associated with portal vein thrombosis.Conclusions In patients with hepatitis B cirrhosis with esophageal and gastric varices,the characteristics of iron metabolism in patients with portal vein thrombosis are different from those in patients without thrombosis,with higher levels of soluble transferrin receptor and lower levels of ferritin.
Hepatitis BLiver cirrhosisEsophageal and gastric varicesPortal vein thrombosisIron metabolism
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