肝硬化合并门静脉血栓形成机制
The Mechanism of Portal Vein Thrombosis Combined with Liver Cirrhosis
DOI: 10.12677/acm.2025.153782, PDF,   
作者: 蓝 帆*, 高 敏#:浙江大学医学院附属邵逸夫医院消化内科,浙江 杭州
关键词: 肝硬化门静脉血栓Liver Cirrhosis Portal Vein Thrombosis
摘要: 门静脉血栓(portal vein thrombosis, PVT)是肝硬化患者中的罕见并发症。肝硬化患者合并PVT可引起一系列并发症,通常指向肝硬化患者的不良预后。肝硬化患者并发PVT的机制涉及血流动力学因素、局部血管损伤、凝血功能变化、内皮功能障碍、炎症反应、肠道菌群失调、遗传因素、门静脉高压等方面。PVT的发生往往是隐匿的,探寻肝硬化合并PVT的机制有助于临床更好地诊断及治疗。现有的研究结果表明,PVT的形成是多因素共同作用的结果,其中门静脉高压和血流动力学因素是主要的驱动因素,而凝血功能变化、内皮功能障碍和炎症反应则是次要的促进因素。
Abstract: Portal vein thrombosis (PVT) is an uncommon complication for patients with cirrhosis. PVT in patients with cirrhosis can lead to a number of complications, often pointing to a poor prognosis in patients with cirrhosis. The mechanism of PVT in cirrhotic patients involves hemodynamic factors, local vascular injury, changes in coagulation function, endothelial dysfunction, inflammatory response, intestinal flora disorder, genetic factors, portal hypertension and so on. The occurrence of PVT is often hidden, and exploring the mechanism of cirrhosis complicated with PVT is helpful for better clinical diagnosis and treatment. The existing research findings indicate that the formation of PVT is the result of the combined effects of multiple factors, with portal hypertension and hemodynamic factors serving as the primary drivers, while changes in coagulation function, endothelial dysfunction, and inflammatory responses act as secondary contributing factors.
文章引用:蓝帆, 高敏. 肝硬化合并门静脉血栓形成机制[J]. 临床医学进展, 2025, 15(3): 1604-1612. https://doi.org/10.12677/acm.2025.153782

参考文献

[1] Ginès, P., Krag, A., Abraldes, J.G., Solà, E., Fabrellas, N. and Kamath, P.S. (2021) Liver Cirrhosis. The Lancet, 398, 1359-1376. [Google Scholar] [CrossRef] [PubMed]
[2] Wong, R.J., Kachru, N., Martinez, D.J., Moynihan, M., Ozbay, A.B. and Gordon, S.C. (2020) Real-World Comorbidity Burden, Health Care Utilization, and Costs of Nonalcoholic Steatohepatitis Patients with Advanced Liver Diseases. Journal of Clinical Gastroenterology, 55, 891-902. [Google Scholar] [CrossRef] [PubMed]
[3] Northup, P.G., Garcia‐Pagan, J.C., Garcia‐Tsao, G., Intagliata, N.M., Superina, R.A., Roberts, L.N., et al. (2021) Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients with Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology, 73, 366-413. [Google Scholar] [CrossRef] [PubMed]
[4] Basit, S.A., Stone, C.D. and Gish, R. (2015) Portal Vein Thrombosis. Clinics in Liver Disease, 19, 199-221. [Google Scholar] [CrossRef] [PubMed]
[5] Pan, J., Wang, L., Gao, F., An, Y., Yin, Y., Guo, X., et al. (2022) Epidemiology of Portal Vein Thrombosis in Liver Cirrhosis: A Systematic Review and Meta-analysis. European Journal of Internal Medicine, 104, 21-32. [Google Scholar] [CrossRef] [PubMed]
[6] Ögren, M. (2006) Portal Vein Thrombosis: Prevalence, Patient Characteristics and Lifetime Risk: A Population Study Based on 23796 Consecutive Autopsies. World Journal of Gastroenterology, 12, 2115-2119. [Google Scholar] [CrossRef] [PubMed]
[7] Intagliata, N.M., Caldwell, S.H. and Tripodi, A. (2019) Diagnosis, Development, and Treatment of Portal Vein Thrombosis in Patients with and without Cirrhosis. Gastroenterology, 156, 1582-1599.e1. [Google Scholar] [CrossRef] [PubMed]
[8] Lv, Y., He, C., Wang, Z., Guo, W., Wang, J., Bai, W., et al. (2017) Association of Nonmalignant Portal Vein Thrombosis and Outcomes after Transjugular Intrahepatic Portosystemic Shunt in Patients with Cirrhosis. Radiology, 285, 999-1010. [Google Scholar] [CrossRef] [PubMed]
[9] Lv, Y., Bai, W., Zhu, X., Xue, H., Zhao, J., Zhuge, Y., et al. (2023) Association of Nonmalignant Portal Vein Thrombosis and Clinical Outcomes in Patients with Cirrhosis and Acute Variceal Bleeding: A Multicenter Observational Study. Hepatology International, 17, 1192-1204. [Google Scholar] [CrossRef] [PubMed]
[10] Mantaka, A. (2018) Portal Vein Thrombosis in Cirrhosis: Diagnosis, Natural History, and Therapeutic Challenges. Annals of Gastroenterology, 31, 1-5. [Google Scholar] [CrossRef] [PubMed]
[11] D’Amico, G. and De Franchis, R. (2003) Upper Digestive Bleeding in Cirrhosis. Post-Therapeutic Outcome and Prognostic Indicators. Hepatology, 38, 599-612. [Google Scholar] [CrossRef] [PubMed]
[12] Dell’Era, A., Iannuzzi, F., Fabris, F.M., Fontana, P., Reati, R., Grillo, P., et al. (2014) Impact of Portal Vein Thrombosis on the Efficacy of Endoscopic Variceal Band Ligation. Digestive and Liver Disease, 46, 152-156. [Google Scholar] [CrossRef] [PubMed]
[13] Shukla, A. and Giri, S. (2022) Portal Vein Thrombosis in Cirrhosis. Journal of Clinical and Experimental Hepatology, 12, 965-979. [Google Scholar] [CrossRef] [PubMed]
[14] Guerrero, A., Campo, L.d., Piscaglia, F., Scheiner, B., Han, G., Violi, F., et al. (2023) Anticoagulation Improves Survival in Patients with Cirrhosis and Portal Vein Thrombosis: The IMPORTAL Competing-Risk Meta-Analysis. Journal of Hepatology, 79, 69-78. [Google Scholar] [CrossRef] [PubMed]
[15] Qi, X., De Stefano, V., Li, H., Dai, J., Guo, X. and Fan, D. (2015) Anticoagulation for the Treatment of Portal Vein Thrombosis in Liver Cirrhosis: A Systematic Review and Meta-Analysis of Observational Studies. European Journal of Internal Medicine, 26, 23-29. [Google Scholar] [CrossRef] [PubMed]
[16] Zhang, J., Chen, J., Zhou, J., Wang, X., Chen, S., Chu, J., et al. (2021) Systematic Review and Meta-Analysis of Trans-Jugular Intrahepatic Portosystemic Shunt for Cirrhotic Patients with Portal Vein Thrombosis. World Journal of Clinical Cases, 9, 5179-5190. [Google Scholar] [CrossRef] [PubMed]
[17] Ju, C., Li, X., Gadani, S., Kapoor, B. and Partovi, S. (2021) Portal Vein Thrombosis: Diagnosis and Endovascular Management. RöFoFortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 194, 169-180. [Google Scholar] [CrossRef] [PubMed]
[18] Zhan, C., Prabhu, V., Kang, S.K., Li, C., Zhu, Y., Kim, S., et al. (2021) Comparison of Non-Tumoral Portal Vein Thrombosis Management in Cirrhotic Patients: TIPS versus Anticoagulation versus No Treatment. Journal of Clinical Medicine, 10, Article 2316. [Google Scholar] [CrossRef] [PubMed]
[19] Rajesh, S., George, T., Philips, C.A., Ahamed, R., Kumbar, S., Mohan, N., et al. (2020) Transjugular Intrahepatic Portosystemic Shunt in Cirrhosis: An Exhaustive Critical Update. World Journal of Gastroenterology, 26, 5561-5596. [Google Scholar] [CrossRef] [PubMed]
[20] Seedial, S., Mouli, S. and Desai, K. (2018) Acute Portal Vein Thrombosis: Current Trends in Medical and Endovascular Management. Seminars in Interventional Radiology, 35, 198-202. [Google Scholar] [CrossRef] [PubMed]
[21] Sullivan, I.W., Fonseca, A., Brown, M., Ness, J., Borge, M., Amin, P., et al. (2022) Large Bore Portal Vein Thrombectomy: An Inari Flowtriever Case Series. CardioVascular and Interventional Radiology, 46, 136-141. [Google Scholar] [CrossRef] [PubMed]
[22] Iwakiri, Y. and Trebicka, J. (2021) Portal Hypertension in Cirrhosis: Pathophysiological Mechanisms and Therapy. JHEP Reports, 3, Article ID: 100316. [Google Scholar] [CrossRef] [PubMed]
[23] Zocco, M.A., Stasio, E.D., Cristofaro, R.D., et al. (2009) Thrombotic Risk Factors in Patients with Liver Cirrhosis: Correlation with MELD Scoring System and Portal Vein Thrombosis Development. Journal of Hepatology, 51, 682-689.
[24] Dong, G., Huang, X.Q., Zhu, Y.L., Ding, H., Li, F. and Chen, S.Y. (2021) Increased Portal Vein Diameter Is Predictive of Portal Vein Thrombosis Development in Patients with Liver Cirrhosis. Annals of Translational Medicine, 9, 289.
[25] Turon, F., Driever, E.G., Baiges, A., Cerda, E., García-Criado, Á., Gilabert, R., et al. (2021) Predicting Portal Thrombosis in Cirrhosis: A Prospective Study of Clinical, Ultrasonographic and Hemostatic Factors. Journal of Hepatology, 75, 1367-1376. [Google Scholar] [CrossRef] [PubMed]
[26] Kamath, P.S. and Mookerjee, R.P. (2015) Individualized Care for Portal Hypertension: Not Quite Yet. Journal of Hepatology, 63, 543-545. [Google Scholar] [CrossRef] [PubMed]
[27] Giannitrapani, L., Granà, W., Licata, A., Schiavone, C., Montalto, G. and Soresi, M. (2018) Nontumorous Portal Vein Thrombosis in Liver Cirrhosis: Possible Role of β-Blockers. Medical Principles and Practice, 27, 466-471. [Google Scholar] [CrossRef] [PubMed]
[28] Zanetto, A., Campello, E., Senzolo, M. and Simioni, P. (2023) The Evolving Knowledge on Primary Hemostasis in Patients with Cirrhosis: A Comprehensive Review. Hepatology, 79, 460-481. [Google Scholar] [CrossRef] [PubMed]
[29] Anton, A., Campreciós, G., Pérez-Campuzano, V., Orts, L., García-Pagán, J.C. and Hernández-Gea, V. (2022) The Pathophysiology of Portal Vein Thrombosis in Cirrhosis: Getting Deeper into Virchow’s Triad. Journal of Clinical Medicine, 11, Article 800. [Google Scholar] [CrossRef] [PubMed]
[30] Lisman, T. and Porte, R.J. (2010) Rebalanced Hemostasis in Patients with Liver Disease: Evidence and Clinical Consequences. Blood, 116, 878-885. [Google Scholar] [CrossRef] [PubMed]
[31] Chen, H., Qi, X., He, C., Yin, Z., Fan, D. and Han, G. (2013) Coagulation Imbalance May Not Contribute to the Development of Portal Vein Thrombosis in Patients with Cirrhosis. Thrombosis Research, 131, 173-177. [Google Scholar] [CrossRef] [PubMed]
[32] Tang, W., Wang, Y., Zhao, X., Wang, X., Zhang, T., Ou, X., et al. (2015) Procoagulant Imbalance Aggravated with Falling Liver Function Reserve, but Not Associated with the Presence of Portal Vein Thrombosis in Cirrhosis. European Journal of Gastroenterology & Hepatology, 27, 672-678. [Google Scholar] [CrossRef] [PubMed]
[33] Ren, W., Zhang, J., Chen, Y., Wen, M., Su, Y., Zhao, Y., et al. (2020) Evaluation of Coagulation, Fibrinolysis and Endothelial Biomarkers in Cirrhotic Patients with or without Portal Venous Thrombosis. Clinical and Applied Thrombosis/Hemostasis, 26, 1-7. [Google Scholar] [CrossRef] [PubMed]
[34] La Mura, V., Tripodi, A., Tosetti, G., Cavallaro, F., Chantarangkul, V., Colombo, M., et al. (2016) Resistance to Thrombomodulin Is Associated with de Novo Portal Vein Thrombosis and Low Survival in Patients with Cirrhosis. Liver International, 36, 1322-1330. [Google Scholar] [CrossRef] [PubMed]
[35] Fimognari, F.L., De Santis, A., Piccheri, C., Moscatelli, R., Gigliotti, F., Vestri, A., et al. (2005) Evaluation of D-Dimer and Factor VIII in Cirrhotic Patients with Asymptomatic Portal Venous Thrombosis. Journal of Laboratory and Clinical Medicine, 146, 238-243. [Google Scholar] [CrossRef] [PubMed]
[36] Neubauer, K. and Zieger, B. (2021) Endothelial Cells and Coagulation. Cell and Tissue Research, 387, 391-398. [Google Scholar] [CrossRef] [PubMed]
[37] Bosch, J., Abraldes, J.G., Fernández, M. and García-Pagán, J.C. (2010) Hepatic Endothelial Dysfunction and Abnormal Angiogenesis: New Targets in the Treatment of Portal Hypertension. Journal of Hepatology, 53, 558-567. [Google Scholar] [CrossRef] [PubMed]
[38] Wannhoff, A., Müller, O.J., Friedrich, K., Rupp, C., Klöters-Plachky, P., Leopold, Y., et al. (2014) Effects of Increased Von Willebrand Factor Levels on Primary Hemostasis in Thrombocytopenic Patients with Liver Cirrhosis. PLOS ONE, 9, e112583. [Google Scholar] [CrossRef] [PubMed]
[39] Lisman, T., Bongers, T.N., Adelmeijer, J., Janssen, H.L.A., de Maat, M.P.M., de Groot, P.G., et al. (2006) Elevated Levels of Von Willebrand Factor in Cirrhosis Support Platelet Adhesion Despite Reduced Functional Capacity. Hepatology, 44, 53-61. [Google Scholar] [CrossRef] [PubMed]
[40] Rosado, E., Rodríguez‐Vilarrupla, A., Gracia‐Sancho, J., Monclús, M., Bosch, J. and García‐Pagán, J. (2012) Interaction between No and Cox Pathways Modulating Hepatic Endothelial Cells from Control and Cirrhotic Rats. Journal of Cellular and Molecular Medicine, 16, 2461-2470. [Google Scholar] [CrossRef] [PubMed]
[41] Jiang, S., Ai, Y., Ni, L., Wu, L., Huang, X. and Chen, S. (2022) Platelet-Derived TGF-β1 Is Related to Portal Vein Thrombosis in Cirrhosis by Promoting Hypercoagulability and Endothelial Dysfunction. Frontiers in Cardiovascular Medicine, 9, Article 938397. [Google Scholar] [CrossRef] [PubMed]
[42] Nie, G., Zhang, H., Luo, W., Zhu, X., Xie, D., Yan, J., et al. (2024) Enhancement of Endothelial Function and Attenuation of Portal Vein Injury Using Mesenchymal Stem Cells Carrying miRNA-25-3p. Scientific Reports, 14, Article No. 15113. [Google Scholar] [CrossRef] [PubMed]
[43] Jackson, S.P., Darbousset, R. and Schoenwaelder, S.M. (2019) Thromboinflammation: Challenges of Therapeutically Targeting Coagulation and Other Host Defense Mechanisms. Blood, 133, 906-918. [Google Scholar] [CrossRef] [PubMed]
[44] Hammerich, L. and Tacke, F. (2023) Hepatic Inflammatory Responses in Liver Fibrosis. Nature Reviews Gastroenterology & Hepatology, 20, 633-646. [Google Scholar] [CrossRef] [PubMed]
[45] Huang, X., Fan, X., Zhang, R., Jiang, S., Yang, K. and Chen, S. (2020) Systemic Inflammation and Portal Vein Thrombosis in Cirrhotic Patients with Gastroesophageal Varices. European Journal of Gastroenterology & Hepatology, 32, 401-405. [Google Scholar] [CrossRef] [PubMed]
[46] Arroyo, V., Angeli, P., Moreau, R., Jalan, R., Clària, J., Trebicka, J., et al. (2021) The Systemic Inflammation Hypothesis: Towards a New Paradigm of Acute Decompensation and Multiorgan Failure in Cirrhosis. Journal of Hepatology, 74, 670-685. [Google Scholar] [CrossRef] [PubMed]
[47] Albillos, A., Lario, M. and Álvarez-Mon, M. (2014) Cirrhosis-associated Immune Dysfunction: Distinctive Features and Clinical Relevance. Journal of Hepatology, 61, 1385-1396. [Google Scholar] [CrossRef] [PubMed]
[48] Chãvez-Galãn, L., Olleros, M.L., Vesin, D. and Garcia, I. (2015) Much More than M1 and M2 Macrophages, There Are Also CD169+ and TCR+ Macrophages. Frontiers in Immunology, 6, Article 263. [Google Scholar] [CrossRef] [PubMed]
[49] Xu, L., Huang, C., Zheng, X., Gao, H., Zhang, S., Zhu, M., et al. (2024) Elevated CD169 Expressing Monocyte/Macrophage Promotes Systemic Inflammation and Disease Progression in Cirrhosis. Clinical and Experimental Medicine, 24, Article No. 45. [Google Scholar] [CrossRef] [PubMed]
[50] Qin, J., Li, R., Raes, J., Arumugam, M., Burgdorf, K.S., Manichanh, C., et al. (2010) A Human Gut Microbial Gene Catalogue Established by Metagenomic Sequencing. Nature, 464, 59-65. [Google Scholar] [CrossRef] [PubMed]
[51] Bäckhed, F., Roswall, J., Peng, Y., Feng, Q., Jia, H., Kovatcheva-Datchary, P., et al. (2015) Dynamics and Stabilization of the Human Gut Microbiome during the First Year of Life. Cell Host & Microbe, 17, 690-703. [Google Scholar] [CrossRef] [PubMed]
[52] Adak, A. and Khan, M.R. (2018) An Insight into Gut Microbiota and Its Functionalities. Cellular and Molecular Life Sciences, 76, 473-493. [Google Scholar] [CrossRef] [PubMed]
[53] Huang, X., Zhang, Y., Yi, S., Lei, L., Ma, T., Huang, R., et al. (2023) Potential Contribution of the Gut Microbiota to the Development of Portal Vein Thrombosis in Liver Cirrhosis. Frontiers in Microbiology, 14, Article 1217338. [Google Scholar] [CrossRef] [PubMed]
[54] Farquhar, M.G. and Palade, G.E. (1963) Junctional Complexes in Various Epithelia. The Journal of Cell Biology, 17, 375-412. [Google Scholar] [CrossRef] [PubMed]
[55] Ghosh, S., Whitley, C.S., Haribabu, B. and Jala, V.R. (2021) Regulation of Intestinal Barrier Function by Microbial Metabolites. Cellular and Molecular Gastroenterology and Hepatology, 11, 1463-1482. [Google Scholar] [CrossRef] [PubMed]
[56] Trebicka, J., Bork, P., Krag, A. and Arumugam, M. (2020) Utilizing the Gut Microbiome in Decompensated Cirrhosis and Acute-on-Chronic Liver Failure. Nature Reviews Gastroenterology & Hepatology, 18, 167-180. [Google Scholar] [CrossRef] [PubMed]
[57] Fukui, H. (2015) Gut-Liver Axis in Liver Cirrhosis: How to Manage Leaky Gut and Endotoxemia. World Journal of Hepatology, 7, 425-442. [Google Scholar] [CrossRef] [PubMed]
[58] Violi, F., Pignatelli, P., Castellani, V., Carnevale, R. and Cammisotto, V. (2023) Gut Dysbiosis, Endotoxemia and Clotting Activation: A Dangerous Trio for Portal Vein Thrombosis in Cirrhosis. Blood Reviews, 57, Article ID: 100998. [Google Scholar] [CrossRef] [PubMed]
[59] Klute, K., DeFilippis, E.M., Shillingford, K., Chapin, J. and DeSancho, M.T. (2016) Clinical Presentations, Risk Factors, Treatment and Outcomes in Patients with Splanchnic Vein Thrombosis: A Single-Center Experience. Journal of Thrombosis and Thrombolysis, 42, 267-271. [Google Scholar] [CrossRef] [PubMed]
[60] Galli, M., Gianni, M., Ageno, W. and Dentali, F. (2008) Inherited Thrombophilic Abnormalities and Risk of Portal Vein Thrombosis. Thrombosis and Haemostasis, 99, 675-682. [Google Scholar] [CrossRef] [PubMed]
[61] Ma, S.D., Wang, J., Bezinover, D., Kadry, Z., Northup, P.G. and Stine, J.G. (2019) Inherited Thrombophilia and Portal Vein Thrombosis in Cirrhosis: A Systematic Review and Meta‐analysis. Research and Practice in Thrombosis and Haemostasis, 3, 658-667. [Google Scholar] [CrossRef] [PubMed]
[62] Qi, X., Ren, W., De Stefano, V. and Fan, D. (2014) Associations of Coagulation Factor V Leiden and Prothrombin G20210A Mutations with Budd-Chiari Syndrome and Portal Vein Thrombosis: A Systematic Review and Meta-Analysis. Clinical Gastroenterology and Hepatology, 12, 1801-1812.e7. [Google Scholar] [CrossRef] [PubMed]
[63] Janssen, H.L.A., Meinardi, J.R., Vleggaar, F.P. and van Hattum, J. (2000) 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, 96, 2364-2368.
[64] Fortea, J.I., Carrera, I.G., Puente, Á., Cuadrado, A., Huelin, P., Tato, C.Á., et al. (2020) Portal Thrombosis in Cirrhosis: Role of Thrombophilic Disorders. Journal of Clinical Medicine, 9, Article 2822. [Google Scholar] [CrossRef] [PubMed]
[65] Tremblay, D., Naymagon, L., Troy, K., Cromwell, C., Edwards, C., Schiano, T., et al. (2020) The Utility of Thrombophilia Testing in Patients with Newly Diagnosed Portal Vein Thrombosis. Blood Coagulation & Fibrinolysis, 31, 213-218. [Google Scholar] [CrossRef] [PubMed]
[66] Zarrouk, M., Salim, S., Elf, J., Gottsäter, A. and Acosta, S. (2017) Testing for Thrombophilia in Mesenteric Venous Thrombosis—Retrospective Original Study and Systematic Review. Best Practice & Research Clinical Gastroenterology, 31, 39-48. [Google Scholar] [CrossRef] [PubMed]
[67] Shetty, S., Kulkarni, B., Pai, N., Mukundan, P., Kasatkar, P. and Ghosh, K. (2010) JAK2 Mutations across a Spectrum of Venous Thrombosis Cases. American Journal of Clinical Pathology, 134, 82-85. [Google Scholar] [CrossRef] [PubMed]
[68] Pasta, L., Pasta, F. and D’Amico, M. (2016) PAI-1 4G-4G, MTHFR 677TT, V Leiden 506Q, and Prothrombin 20210A in Splanchnic Vein Thrombosis: Analysis of Individual Patient Data from Three Prospective Studies. Journal of Clinical and Experimental Hepatology, 6, 10-14. [Google Scholar] [CrossRef] [PubMed]
[69] Tektonidou, M.G., Andreoli, L., Limper, M., Amoura, Z., Cervera, R., Costedoat-Chalumeau, N., et al. (2019) EULAR Recommendations for the Management of Antiphospholipid Syndrome in Adults. Annals of the Rheumatic Diseases, 78, 1296-1304. [Google Scholar] [CrossRef] [PubMed]
[70] Kirkeby, M.H., Larsen, J.B., Grønbaek, H. and Hvas, A. (2020) Thrombophilia Testing in Patients with Portal Vein Thrombosis. Scandinavian Journal of Clinical and Laboratory Investigation, 80, 694-698. [Google Scholar] [CrossRef] [PubMed]
[71] Zou, C., Li, T., Long, L., Liu, L. and Zhu, J. (2022) Hereditary Protein C Deficiency with Portal Vein Thrombosis in a Chinese Male: A Case Report. Experimental and Therapeutic Medicine, 24, Article No. 751. [Google Scholar] [CrossRef] [PubMed]