High Incidence of Hepatitis B Infection-Associated Cirrhosis and Hepatocellular Carcinoma in the Southeast Asian Patients with Portal Vein Thrombosis

BMC Gastroenterology

Chirayu U Auewarakul¹  Korn Lertpipopmetha¹ 

[1] Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

关键词: Southeast Asia;    HBV infection;    hepatocellular carcinoma;    cirrhosis;    risk factors;    incidence;    portal vein thrombosis;   

Others  :  1114487
DOI  :  10.1186/1471-230X-11-66

 received in 2011-02-25, accepted in 2011-06-10,  发布年份 2011

【 摘 要 】

Background

Portal vein thrombosis (PVT) is a rare condition associated with serious morbidity and mortality. The objective of this study was to determine the frequency, clinical presentations, and risk factors of PVT from the set of data firstly collected among the Southeast Asian population.

Methods

A retrospective study was undertaken to identify patients diagnosed with thrombosis of the portal system and other abdominal veins. The hospital medical records were retrieved based on the selected ICD-10 codes. Clinical presentations were collected and risk factors determined.

Results

From 2000-2009, 467 hospital charts with designated ICD-10 codes of I81, I82.2, I82.3, I82.8, I82.9, or K55.0 were identified. PVT (I81) was the most common thrombosis (194 cases, 41.54%). The majority of PVT patients were males (65%), older than 40 years (75%), and presented with abdominal distension/ascites (69%), splenomegaly (54.6%), and abdominal pain (50.5%). Overall, the predominant risk factor was hepatocellular carcinoma (HCC) (52.5%), followed by liver cirrhosis without cancer (9.3%), abdominal infection/inflammation (9.3%), cholangiocarcinoma (8.2%), and abdominal intervention (7.7%). In young patients, abdominal interventions including umbilical catheterization (23.1%) and hepatectomy (7.7%) were the most frequent risks whereas in older cases, primary hepatobiliary cancer and cirrhosis (78%) were the major risks. Liver metastases from other organs were infrequently found. Chronic hepatitis B virus (HBV) infection was the main etiology associated with cirrhosis/HCC leading to PVT in this cohort. A third of the older PVT patients (age

>

40) had HBV and very few carried hepatitis C virus (HCV) whereas none of the young PVT patients (age <20) had HBV or HCV. A variety of abdominal infections/inflammations were also found including liver abscess, splenic abscess, cholangitis, cholecystitis, pancreatitis, omphalitis, and abdominal tuberculosis. Single cases of systemic lymphangiomatosis and Klippel-Trénaunay vascular malformation syndrome were also identified. Other thrombophilic conditions such as myeloproliferative neoplasms, paroxysmal nocturnal hemoglobinuria, protein S deficiency, and anti-phospholipid syndrome were rarely encountered.

Conclusion

HBV is the major risk of PVT in the Southeast Asian population. Several risk factors identified in this population have rarely been described and some are remarkably different from those reported in the West. Host and environmental factors may play a causal role in the initiation and development of PVT in various ethnicities and geographic locations.

【 授权许可】

   
2011 Lertpipopmetha and Auewarakul; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Ogren M, Bergqvist D, Bjorck M, Acosta S, Eriksson H, Sternby NH: Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies. World J Gastroenterol 2006, 12:2115-2119.
• [2]Hoekstra J, Janssen HL: Vascular liver disorders (II): portal vein thrombosis. Neth J Med 2009, 67:46-53.
• [3]Amitrano L, Guardascione MA, Brancaccio V, Margaglione M, Manguso F, Iannaccone L, Grandone E, Balzano A: Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. J Hepatol 2004, 40:736-741.
• [4]DeLeve LD, Valla DC, Garcia-Tsao G: Vascular disorders of the liver. Hepatology 2009, 49:1729-1764.
• [5]Poddar U, Thapa BR, Rao KL, Singh K: Etiological spectrum of esophageal varices due to portal hypertension in Indian children: is it different from the West? J Gastroenterol Hepatol 2008, 23:1354-1357.
• [6]Sogaard KK, Astrup LB, Vilstrup H, Gronbaek H: Portal vein thrombosis; risk factors, clinical presentation and treatment. BMC Gastroenterol 2007, 7:34. BioMed Central Full Text
• [7]Gaiani S, Bolondi L, Li Bassi S, Zironi G, Siringo S, Barbara L: Prevalence of spontaneous hepatofugal portal flow in liver cirrhosis. Clinical and endoscopic correlation in 228 patients. Gastroenterology 1991, 100:160-167.
• [8]Arora NK, Lodha R, Gulati S, Gupta AK, Mathur P, Joshi MS, Arora N, Mitra DK: Portal hypertension in north Indian children. Indian J Pediatr 1998, 65:585-591.
• [9]Kulungowski AM, Fox VL, Burrows PE, Alomari AI, Fishman SJ: Portomesenteric venous thrombosis associated with rectal venous malformations. J Pediatr Surg 45:1221-1227.
• [10]de Souza LM, Bentlin MR, de Abreu ES, Bacchi CE: Systemic congenital lymphangiomatosis. Sao Paulo Med J 1996, 114:1278-1281.
• [11]Aguas M, Bastida G, Nos P, Beltran B, Grueso JL, Grueso J: Septic thrombophlebitis of the superior mesenteric vein and multiple liver abscesses in a patient with Crohn's disease at onset. BMC Gastroenterol 2007, 7:22. BioMed Central Full Text
• [12]Condat B, Pessione F, Helene Denninger M, Hillaire S, Valla D: Recent Portal or Mesenteric Venous Thrombosis: Increased Recognition and Frequent Recanalization on Anticoagulant Therapy. Hepatology 2000, 32:466-470.
• [13]Egawa H, Tanaka K, Kasahara M, Takada Y, Oike F, Ogawa K, Sakamoto S, Kozaki K, Taira K, Ito T: Single center experience of 39 patients with preoperative portal vein thrombosis among 404 adult living donor liver transplantations. Liver Transpl 2006, 12:1512-1518.
• [14]Fan J, Zhou J, Wu ZQ, Qiu SJ, Wang XY, Shi YH, Tang ZY: Efficacy of different treatment strategies for hepatocellular carcinoma with portal vein tumor thrombosis. World J Gastroenterol 2005, 11:1215-1219.
• [15]Huang JW, Wu MS, Chu TS, Tsai TJ: Hepatic aneurysm and portal vein thrombosis in a patient with lupus erythematosus on dialysis. Nephrol Dial Transplant 1999, 14:753-756.
• [16]Janssen HL, Wijnhoud A, Haagsma EB, van Uum SH, van Nieuwkerk CM, Adang RP, Chamuleau RA, van Hattum J, Vleggaar FP, Hansen BE, et al.: Extrahepatic portal vein thrombosis: aetiology and determinants of survival. Gut 2001, 49:720-724.
• [17]Okuda K, Ohnishi K, Kimura K, Matsutani S, Sumida M, Goto N, Musha H, Takashi M, Suzuki N, Shinagawa T, et al.: Incidence of portal vein thrombosis in liver cirrhosis. An angiographic study in 708 patients. Gastroenterology 1985, 89:279-286.
• [18]Orloff MJ, Orloff MS, Orloff SL, Girard B: Portal vein thrombosis in cirrhosis with variceal hemorrhage. J Gastrointest Surg 1997, 1:123-130, discussion 130-121.
• [19]Plemmons RM, Dooley DP, Longfield RN: Septic thrombophlebitis of the portal vein (pylephlebitis): diagnosis and management in the modern era. Clin Infect Dis 1995, 21:1114-1120.
• [20]Stuart KE, Anand AJ, Jenkins RL: Hepatocellular carcinoma in the United States. Prognostic features, treatment outcome, and survival. Cancer 1996, 77:2217-2222.
• [21]Webb LJ, Sherlock S: The aetiology, presentation and natural history of extra-hepatic portal venous obstruction. Q J Med 1979, 48:627-639.
• [22]Yoshida M, Watanabe Y, Horiuchi A, Yamamoto Y, Sugishita H, Kawachi K: Portal and splenic venous thrombosis after splenectomy in patients with hypersplenism. Hepatogastroenterology 2009, 56:538-541.
• [23]Zhang XB, Wang JH, Yan ZP, Qian S, Du SS, Zeng ZC: Hepatocellular carcinoma with main portal vein tumor thrombus: treatment with 3-dimensional conformal radiotherapy after portal vein stenting and transarterial chemoembolization. Cancer 2009, 115:1245-1252.
• [24]Plessier A, Darwish-Murad S, Hernandez-Guerra M, Consigny Y, Fabris F, Trebicka J, Heller J, Morard I, Lasser L, Langlet P, et al.: Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology 51:210-218.
• [25]Qi X, Bai M, Yang Z, Yuan S, Zhang C, Han G, Fan D: Occlusive portal vein thrombosis as a new marker of decompensated cirrhosis. Med Hypotheses
• [26]Beasley RP: Rocks along the road to the control of HBV and HCC. Ann Epidemiol 2009, 19:231-234.
• [27]Dultz G, Kronenberger B, Azizi A, Mihm U, Vogl TJ, Sarrazin U, Sarrazin C, Zeuzem S, Hofmann WP: Portal vein thrombosis as complication of romiplostim treatment in a cirrhotic patient with hepatitis C-associated immune thrombocytopenic purpura. J Hepatol
• [28]Poovorawan Y, Chongsrisawat V, Theamboonlers A, Leroux-Roels G, Kuriyakose S, Leyssen M, Jacquet JM: Evidence of protection against clinical and chronic hepatitis B infection 20 years after infant vaccination in a high endemicity region. J Viral Hepat
• [29]Sa-Nguanmoo P, Tangkijvanich P, Thawornsuk N, Vichaiwattana P, Prianantathavorn K, Theamboonlers A, Tanaka Y, Poovorawan Y: Molecular epidemiological study of hepatitis B virus among migrant workers from Cambodia, Laos, and Myanmar to Thailand. J Med Virol 82:1341-1349.
• [30]Pietrobattista A, Luciani M, Abraldes JG, Candusso M, Pancotti S, Soldati M, Monti L, Torre G, Nobili V: Extrahepatic portal vein thrombosis in children and adolescents: Influence of genetic thrombophilic disorders. World J Gastroenterol 16:6123-6127.
• [31]Kameda H, Yamazaki K, Imai F, Sugiura M, Nakashima T, Okuda K, The Japanese Ministry Of Health Welfare Research Committee On Idiopathic Portal H: Obliterative portal venopathy: A comparative study of 184 cases of extrahepatic portal obstruction and 469 cases of idiopathic portal hypertension. Journal of Gastroenterology and Hepatology 1986, 1:139-149.
• [32]Angchaisuksiri P, Atichartakarn V, Aryurachai K, Archararit N, Rachakom B, Atamasirikul K, Tiraganjana A: Risk factors of venous thromboembolism in thai patients. Int J Hematol 2007, 86:397-402.
• [33]Sirachainan N, Chuansumrit A, Angchaisuksiri P, Pakakasama S, Hongeng S, Kadegasem P: Venous thromboembolism in Thai children. Pediatr Hematol Oncol 2007, 24:245-256.
• [34]Sharma S, Kumar SI, Poddar U, Yachha SK, Aggarwal R: Factor V Leiden and prothrombin gene G20210A mutations are uncommon in portal vein thrombosis in India. Indian J Gastroenterol 2006, 25:236-239.
• [35]Kruatrachue M, Wasi P, Na-Nakorn S: Paroxysmal nocturnal haemoglobinuria in Thailand with special reference to as association with aplastic anaemia. Br J Haematol 1978, 39:267-276.
• [36]Rosse WF, Nishimura J: Clinical manifestations of paroxysmal nocturnal hemoglobinuria: present state and future problems. Int J Hematol 2003, 77:113-120.
• [37]Kannim S, Auewarakul CU: The impact of JAK2 non-receptor tyrosine kinase mutation on the mobilization of hematopoietic stem cells into peripheral blood of patients with Philadelphia chromosome-negative myeloproliferative disorders. Int J Cancer 2009, 125:988-990.
• [38]Kurathong S, Lerdverasirikul P, Wongpaitoon V, Pramoolsinsap C, Kanjanapitak A, Varavithya W, Phuapradit P, Bunyaratvej S, Upatham ES, Brockelman WY: Opisthorchis viverrini infection and cholangiocarcinoma. A prospective, case-controlled study. Gastroenterology 1985, 89:151-156.
• [39]Shin HR, Oh JK, Masuyer E, Curado MP, Bouvard V, Fang Y, Wiangnon S, Sripa B, Hong ST: Comparison of Incidence of Intrahepatic and Extrahepatic Cholangiocarcinoma - Focus on East and South-eastern Asia. Asian Pac J Cancer Prev 11:1159-1166.
• [40]Gertsch P, Matthews J, Lerut J, Luder P, Blumgart LH: Acute thrombosis of the splanchnic veins. Arch Surg 1993, 128:341-345.
• [41]Miller VE, Berland LL: Pulsed Doppler duplex sonography and CT of portal vein thrombosis. AJR Am J Roentgenol 1985, 145:73-76.
• [42]Parvey HR, Eisenberg RL, Giyanani V, Krebs CA: Duplex sonography of the portal venous system: pitfalls and limitations. AJR Am J Roentgenol 1989, 152:765-770.
• [43]Tessler FN, Gehring BJ, Gomes AS, Perrella RR, Ragavendra N, Busuttil RW, Grant EG: Diagnosis of portal vein thrombosis: value of color Doppler imaging. AJR Am J Roentgenol 1991, 157:293-296.
• [44]Chawla Y, Duseja A, Dhiman RK: Review article: the modern management of portal vein thrombosis. Aliment Pharmacol Ther 2009, 30:881-894.
• [45]Haddad MC, Clark DC, Sharif HS, al Shahed M, Aideyan O, Sammak BM: MR, CT, and ultrasonography of splanchnic venous thrombosis. Gastrointest Radiol 1992, 17:34-40.
• [46]Zirinsky K, Markisz JA, Rubenstein WA, Cahill PT, Knowles RJ, Auh YH, Morrison H, Kazam E: MR imaging of portal venous thrombosis: correlation with CT and sonography. AJR Am J Roentgenol 1988, 150:283-288.
• [47]Lu ZH, Shen F, Yan ZL, Li J, Yang JH, Zong M, Shi LH, Wu MC: Treatment of portal vein tumor thrombus of hepatocellular carcinoma with percutaneous laser ablation. J Cancer Res Clin Oncol 2009, 135:783-789.