Thromb Haemost 2013; 109(05): 878-884
DOI: 10.1160/TH12-10-0784
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Thrombotic risk factors in Chinese Budd-Chiari syndrome patients

An observational study with a systematic review of the literature
Xingshun Qi*
1   Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
,
Feifei Wu*
1   Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
,
Weirong Ren*
1   Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
,
Chuangye He
1   Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
,
Zhanxin Yin
1   Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
,
Jing Niu
1   Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
,
Ming Bai
1   Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
,
Zhiping Yang
1   Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
,
Kaichun Wu
1   Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
2   State Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi’an, China
,
Daiming Fan
1   Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
2   State Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi’an, China
,
Guohong Han
1   Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received: 30. Oktober 2012

Accepted after major revision: 09. Februar 2013

Publikationsdatum:
22. November 2017 (online)

Summary

In Western countries, thrombotic risk factors for Budd-Chiari syndrome (BCS) are very common, including factor V Leiden mutation, prothrombin G20210A mutation, myeloproliferative neoplasms, paroxysmal nocturnal haemoglobinuria, etc. However, the data regarding thrombotic risk factors in Chinese BCS patients are extremely limited. An observational study was conducted to examine this issue. A total of 246 BCS patients who were consecutively admitted to our department between July 1999 and December 2011 were invited to be examined for thrombotic risk factors. Of these, 169 patients were enrolled. Neither factor V Leiden mutation nor prothrombin G20210A mutation was found in any of 136 patients tested. JAK2 V617F mutation was positive in four of 169 patients tested. Neither MPL W515L/K mutation nor JAK2 exon 12 mutation was found in any of 135 patients tested. Overt myeloproliferative neoplasms were diagnosed in five patients (polycythemia vera, n=3; essential thrombocythemia, n=1; idiopathic myelofibrosis, n=1). Two of them had positive JAK2 V617F mutation. Both CD55 and CD59 deficiencies were found in one of 166 patients tested. This patient had a previous history of paroxysmal nocturnal haemoglobinuria before BCS. Anticardiolipin IgG antibodies were positive or weakly positive in six of 166 patients tested. Hyperhomocysteinaemia was found in 64 of 128 patients tested. 5,10-methylenetetrahydrofolate reductase C677T mutation was found in 96 of 135 patients tested. In conclusion, factor V Leiden mutation, prothrombin G20210A mutation, myeloproliferative neoplasms, and paroxysmal nocturnal haemoglobinuria are very rare in Chinese BCS patients, suggesting that the etiological distribution of BCS might be different between Western countries and China.

* The first three authors contributed equally to this study.


 
  • References

  • 1 DeLeve LD, Valla DC, Garcia-Tsao G. Vascular disorders of the liver. Hepatology 2009; 49: 1729-1764.
  • 2 Valla DC. Primary Budd-Chiari syndrome. J Hepatol 2009; 50: 195-203.
  • 3 De Stefano V, Martinelli I. Splanchnic vein thrombosis: clinical presentation, risk factors and treatment. Intern Emerg Med 2010; 05: 487-494.
  • 4 Senzolo M, Riggio O, Primignani M. Vascular disorders of the liver: recommendations from the Italian Association for the Study of the Liver (AISF) ad hoc committee. Dig Liver Dis 2011; 43: 503-514.
  • 5 Riva N, Donadini MP, Dentali F. et al. Clinical approach to splanchnic vein thrombosis: Risk factors and treatment. Thromb Res 2012; 130 (Suppl. 01) S1-3.
  • 6 Janssen HL, Meinardi JR, Vleggaar FP. et al. Factor V Leiden mutation, prothrombin gene mutation, and deficiencies in coagulation inhibitors associated with Budd-Chiari syndrome and portal vein thrombosis: results of a case-control study. Blood 2000; 96: 2364-2368.
  • 7 Denninger MH, Chait Y, Casadevall N. et al. Cause of portal or hepatic venous thrombosis in adults: the role of multiple concurrent factors. Hepatology 2000; 31: 587-591.
  • 8 Darwish Murad S, Plessier A, Hernandez-Guerra M. et al. Etiology, management, and outcome of the Budd-Chiari syndrome. Ann Intern Med 2009; 151: 167-175.
  • 9 Deltenre P, Denninger MH, Hillaire S. et al. Factor V Leiden related Budd-Chiari syndrome. Gut 2001; 48: 264-268.
  • 10 James C, Ugo V, Le Couedic JP. et al. A unique clonal JAK2 mutation leading to constitutive signalling causes polycythaemia vera. Nature 2005; 434: 1144-1148.
  • 11 Baxter EJ, Scott LM, Campbell PJ. et al. Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders. Lancet 2005; 365: 1054-1061.
  • 12 Kiladjian JJ, Cervantes F, Leebeek FW, Marzac C, Cassinat B, Chevret S, Cazals-Hatem D. et al. The impact of JAK2 and MPL mutations on diagnosis and prognosis of splanchnic vein thrombosis: a report on 241 cases. Blood 2008; 111: 4922-4929.
  • 13 Dentali F, Squizzato A, Brivio L. et al. JAK2V617F mutation for the early diagnosis of Ph- myeloproliferative neoplasms in patients with venous thromboembolism: a meta-analysis. Blood 2009; 113: 5617-5623.
  • 14 Qi X, Yang Z, Bai M. et al. Meta-analysis: the significance of screening for JAK2V617F mutation in Budd-Chiari syndrome and portal venous system thrombosis. Aliment Pharmacol Ther 2011; 33: 1087-1103.
  • 15 Qi X, Zhang C, Han G. et al. Prevalence of the JAK2V617F mutation in Chinese patients with Budd-Chiari syndrome and portal vein thrombosis: A prospective study. J Gastroenterol Hepatol 2012; 27: 1036-1043.
  • 16 Lin GL, Xu PQ, Qi H. et al. Relations of Budd-Chiari syndrome to prothrombin gene mutation. Hepatobiliary Pancreat Dis Int 2004; 03: 214-218.
  • 17 Wang ZG, Zhang FJ, Yi MQ. et al. Evolution of management for Budd-Chiari syndrome: a team’s view from 2564 patients. ANZ J Surg 2005; 75: 55-63.
  • 18 Xu PQ, Ma XX, Ye XX. et al. Surgical treatment of 1360 cases of Budd-Chiari syndrome: 20-year experience. Hepatobiliary Pancreat Dis Int 2004; 03: 391-394.
  • 19 Gao Y, Chen S, Yu C. Applicability of different endovascular methods for treatment of refractory Budd-Chiari syndrome. Cell Biochem Biophys 2011; 61: 453-460.
  • 20 Meng QY, Sun NF, Wang JX. et al. Endovascular treatment of Budd-Chiari syndrome. Chin Med J (Engl) 2011; 124: 3289-3292.
  • 21 Qi X, He C, Han G. et al. Prevalence of paroxysmal nocturnal hemoglobinuria in Chinese patients with Budd-Chiari syndrome or portal vein thrombosis. J Gastroenterol Hepatol 2013; 28: 148-152.
  • 22 Vardiman JW, Thiele J, Arber DA. et al. The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood 2009; 114: 937-951.
  • 23 Fermo I, Vigano’ D’Angelo S. et al. Prevalence of moderate hyperhomocysteinemia in patients with early-onset venous and arterial occlusive disease. Ann Intern Med 1995; 123: 747-753.
  • 24 Lin JS, Shen MC, Tsai W. et al. The prevalence of C677T mutation in the methylenetetrahydrofolate reductase gene and its association with venous thrombophilia in Taiwanese Chinese. Thromb Res 2000; 97: 89-94.
  • 25 Young C, Horton R. Putting clinical trials into context. Lancet 2005; 366: 107-108.
  • 26 Clarke M. Doing new research? Don’t forget the old. PLoS Med 2004; 01: e35.
  • 27 Feng B, Xu K, Jiang H. et al. Relationship between factor V Leiden mutation and Chinese Budd-Chiari syndrome and its clincal significance. Zhonghua Yi Xue Za Zhi (Article in Chinese) 2000; 80: 354-357.
  • 28 Feng B, Xu K, Jin C. et al. Study on relationship between Chinese Budd-Chiari syndrome and factor V Leiden mutation. Zhongguo Yi Ke Da Xue Xue Bao (Article in Chinese) 2001; 30: 53-55.
  • 29 Zhao G, Gu J, Zhang Y. et al. Bai cha zhong he zhong huan ze ning xue mei ji yin G20210A bian yi guan xi yan jiu. Jiangsu Lin Chuang Yi Xue Za Zhi (Abstract and article in Chinese) 2002; 06: 125-129.
  • 30 Li XM, Wei YF, Hao HL. et al. Hyperhomocysteinemia and the MTHFR C677T mutation in Budd-Chiari syndrome. Am J Hematol 2002; 71: 11-14.
  • 31 Wang S, Wei Y, Li J. The relationship between β fibrinogen gene-455G/A polymorphisms and Budd-Chiari syndrome. Zhonghua Nei Ke Za Zhi (Article in Chinese) 2004; 43: 753-755.
  • 32 Guo C, Bian J, Wang Y. et al. Effects of multiple elements in drinking water on inferior vena cava membranous obstruction type of the Budd-Chiari syndrome in Heze area of Shandong Province. Zhongguo Di Fang Bing Xue Za Zhi (Article in Chinese) 2005; 24: 207-209.
  • 33 Zheng H, Lian J, Qi H. et al. FV Leiden and FII G20210A mutations in patients with Budd-Chiari syndrome. Zhengzhou Da Xue Xue Bao 2005; 40: 456-458.
  • 34 He Y, Zheng H, Lian J. et al. Budd-chiari zhong he zheng huan zhe ning xue yin zi XIII Val34Leu ji yin duo tai xing de jian ce. Zhonghua Xue Ye Xue Za Zhi (Abstract and article in Chinese) 2005; 26: 564-565.
  • 35 Lin G, Xu P, Qi H. et al. A study on the correlations between pathogenesis of Budd-Chiari syndrome and Factor V Leiden and Factor II G20210A mutations. Zhonghua Pu Tong Wai Ke Za Zhi (Article in Chinese) 2006; 21: 275-277.
  • 36 Lian J, He Y, Yu H. et al. Distribution of eNOS gene 4a/b VNTR polymorphism in Budd-Chiari syndrome patients in Han population of Henan province. Zhengzhou Da Xue Xue Bao (Article in Chinese) 2007; 42: 422-424.
  • 37 Yu C, Gao Y, Geng X. et al. The research on the mutation of coagulation factor V of diseased tissues in Budd-Chiari syndrome. Lin Chuang Wai Ke Za Zhi (Article in Chinese) 2007; 15: 743-745.
  • 38 Han X, Chen C, Duan G. et al. Budd-Chiari zhong he zheng yu kang lin zhi kang ti zhong he zheng de xiang guan xing yan jiu. Shandong Yi Yao 2008; 48: 109-110.
  • 39 Wang J, Lu Z, Sun G. et al. Bu jia shi zhong he zheng xiang guan wei xian yin su yan jiu. Zhongguo Yi Xue Chuang Xin (Abstract and article in Chinese) 2010; 07: 42-44.
  • 40 Zhang B, Wang L, Liu X. et al. Relation of iodine level of drinking water and coagulation in patients with membrane obstruction of inferior vena cava in Budd-Chiari syndrome. Huan Jing Yu Jian Kang Za Zhi (Article in Chinese) 2011; 28: 44-46.
  • 41 Shen MC, Lin JS, Tsay W. High prevalence of antithrombin III, protein C and protein S deficiency, but no factor V Leiden mutation in venous thrombophilic Chinese patients in Taiwan. Thromb Res 1997; 87: 377-385.
  • 42 Lu Y, Zhao Y, Liu G. et al. Factor V gene G1691A mutation, prothrombin gene G20210A mutation, and MTHFR gene C677T mutation are not risk factors for pulmonary thromboembolism in Chinese population. Thromb Res 2002; 106: 7-12.
  • 43 Yanqing H, Fangping C, Qinzhi X. et al. No association between thrombosis and factor V gene polymorphisms in Chinese Han population. Thromb Haemost 2003; 89: 446-451.
  • 44 Hoekstra J, Leebeek FW, Plessier A. et al. Paroxysmal nocturnal hemoglobinuria in Budd-Chiari syndrome: findings from a cohort study. J Hepatol 2009; 51: 696-706.
  • 45 Garcia-Pagan JC, Heydtmann M, Raffa S. et al. TIPS for Budd-Chiari syndrome: long-term results and prognostics factors in 124 patients. Gastroenterology 2008; 135: 808-815.
  • 46 Bosy-Westphal A, Ruschmeyer M, Czech N. et al. Determinants of hyperhomo-cysteinemia in patients with chronic liver disease and after orthotopic liver transplantation. Am J Clin Nutr 2003; 77: 1269-1277.
  • 47 Mangia A, Margaglione M, Cascavilla I. et al. Anticardiolipin antibodies in patients with liver disease. Am J Gastroenterol 1999; 94: 2983-2987.
  • 48 Hoekstra J, Casellas-Caro M, Garcia-Pagán JC. et al. Etiologic factors underlying Budd-Chiari syndrome and portal vein thrombosis: The role of site-specific thrombosis. Hepatology 2010; 52: 896A.
  • 49 Qi X, De Stefano V, Wang J. et al. Prevalence of inherited antithrombin, protein C, and protein S deficiencies in portal vein system thrombosis and Budd-Chiari syndrome - A systematic review and meta-analysis of observational studies. J Gastroenterol Hepatol 2013; 28: 432-442.
  • 50 Lipe B, Ornstein DL. Deficiencies of natural anticoagulants, protein C, protein S, and antithrombin. Circulation 2011; 124: e365-368.