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Background : Although portal vein thrombosis in cirrhotic patients is frequently observed, the detailed process remains to be clarified, and the role of anticardiolipin antibody in the development of ...portal vein thrombosis has been controversial. Case Report : A 52-year-old man, who had been diagnosed with alcoholic cirrhosis of the liver, was admitted to our hospital suffering from dyspnea and ascites. Just after being diagnosed as having antiphospholipid antibody syndrome with lung thrombosis and delivering a positive result for the β 2-glycoprotein I-dependent anticardiolipin antibody, he sustained rupture of the esophageal varices with rapid development of portal vein thrombosis, which resolved under anticoagulant therapy. Two years later, he was admitted again on suspicion of thrombosis because of an elevation in the serum D-dimer level, and computed tomography showed portal and upper mesenteric vein thrombosis. Although immediate anticoagulant therapy resulted in complete recanalization, he suffered the same episode 2 months later, which occurred with re-elevation of the serum D-dimer level. Conclusion : A positive finding of an anticardiolipin antibody in cirrhotic patients has been considered to be nonspecific and not related to the development of thrombus in the portal vein. This case, however, seems to indicate that cirrhotic patients with the β2-glycoprotein I-dependent anticardiolipin antibody should be regarded as being at high risk for portal vein thrombosis. Monitoring with the serum D-dimer was useful in detecting portal vein thrombosis in its early stage.
肝硬変患者では門脈血栓の発症をしばしば認めるが，その成立機序は十分解明されておらず，抗カルジオリピン抗体の関与も定見がない．今回我々は，繰り返し門脈血栓症を来した抗カルジオリピン抗体陽性の肝硬変患者を経験したので報告する．症例はアルコール性肝硬変と診断されていた52 歳の男性．呼吸困難を主訴に当院に初回入院した際，肺動脈血栓症を伴った抗リン脂質症候群と診断され，β2-glycoprotein I 依存性抗カルジオリピン抗体陽性であることが確認された．入院後に門脈血栓が急速に発症し，食道静脈瘤破裂を来したが，止血後の抗凝固療法で血栓は溶解した．経過観察中の2 年後にD-dimer の上昇から血栓形成を疑われ，CT にて門脈から上腸間膜静脈に至る血栓を認めた．抗凝固療法にて血栓は消失したが，その2ヶ月後には，再度D-dimer の上昇を伴う門脈血栓形成を認めた．肝硬変患者においては抗カルジオリピン抗体は非特異的に陽性化し，門脈血栓症との関係はないとする意見もある．しかし，β2-glycoprotein I 依存性抗カルジオリピン抗体陽性の場合には門脈血栓症の発生と関係がある可能性を，本症例は示唆している．D-dimer の定期観察は，門脈血栓の早期発見に有用である．show more
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