摘要
目的分析抗凝血酶Ⅲ活性与慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)患者生存情况、发生出血和血栓的相关性,探讨抗凝血酶Ⅲ活性对ACLF患者预后的预测价值。方法回顾性分析2013年1月1日至2019年4月1日于无锡市第五人民医院住院的130例ACLF患者的临床资料,检测入院时肝功能指标和国际标准化比值(international normalized ratio,INR),观察患者90 d生存情况。监测入院时和入院后2、4、8周的抗凝血酶Ⅲ活性值,记录患者粪便隐血和股静脉血栓的发生情况。计量资料比较采用t检验、方差分析和秩和检验;计数资料比较采用卡方检验;Cox回归分析影响患者生存情况的风险因素。生存分析采用Kaplan-Meier法。结果入院后观察90 d,130例患者中死亡56例,20例(15.38%)出现粪便隐血阳性,15例(11.54%)有股静脉血栓。死亡组患者的基线抗凝血酶Ⅲ活性为(17.89±13.68)%,低于生存组的(36.03±11.96)%,差异有统计学意义(t=-8.045,P<0.01)。粪便隐血阳性患者和粪便隐血阴性患者的基线抗凝血酶Ⅲ活性分别为(18.26±11.52)%和(25.06±10.97)%;有股静脉血栓患者和无血栓形成患者的基线抗凝血酶Ⅲ活性分别为(17.55±10.33)%和(32.48±11.88)%,组间比较差异均有统计学意义(t=8.746、8.090,均P<0.01)。动态监测患者抗凝血酶Ⅲ活性发现,死亡组患者抗凝血酶Ⅲ活性呈下降趋势,生存组患者呈上升趋势,但差异均无统计学意义(F=0.282、0.401,均P>0.05)。Cox回归分析提示INR[比值比(odds ratio,OR)=1.364,95%CI 1.078~1.726,P=0.010]和基线抗凝血酶Ⅲ活性(OR=0.930,95%CI 0.906~0.954,P<0.01)是影响ACLF患者90 d生存情况的独立影响因素。抗凝血酶Ⅲ活性预测患者90 d生存结局的受试者操作特征曲线下面积为0.706(95%CI 0.773~0.952,P<0.01),临界值为25%。抗凝血酶Ⅲ活性≥25%的患者累积生存率高于抗凝血酶Ⅲ活性<25%的患者(χ^2=58.20,P<0.01)。结论抗凝血酶Ⅲ活性可能与患
Objective To analyze the relationship between antithrombinⅢ(AT-Ⅲ)activity and survival,bleeding and thrombosis complications in patients with acute-on-chronic liver failure(ACLF),and to explore the prediction value of AT-Ⅲactivity in the prognosis of ACLF patients.Methods The clinical data of 130 hospitalized patients with ACLF were retrospectively collected in Wuxi No.5 People′s Hospital from January 1,2013 to April 1,2019.The liver function,international normalized ratio(INR),and 90-day survival rate were detected.The AT-Ⅲactivity values at admission,week two,week four,and week eight of hospitalization were recorded,and the occurrences of fecal occult blood and femoral vein thrombosis were also recorded.The measurement data were compared by t test,analysis of variance,or rank sum test,and the categorical data were compared by chi-square test.The risk factors affecting the survival of ACLF patients were analyzed by Cox regression.The survival analysis was performed using the Kaplan-Meier method.Results At the end of 90-day follow-up of 130 patients,56 patients died,20 patients(15.38%)were fecal occult blood positive and 15(11.54%)had femoral vein thrombosis.The baseline AT-Ⅲactivity in the death group was lower than that in the survival group((17.89±13.68)%vs(36.03±11.96)%),and the difference was statistically significant(t=-8.045,P<0.01).The baseline AT-Ⅲactivities in fecal occult blood positive and negative patients were(18.26±11.52)%and(25.06±10.97)%,respectively,and in femoral vein thrombosis and non-thrombotic patients were(17.55±10.33)%and(32.48±11.88)%,respectively.The differences were both statistically significant(t=8.746 and 8.090,respectively,both P<0.01).Through dynamic monitoring of AT-Ⅲ,the AT-Ⅲactivity showed a downward trend in the death group,while that showed an upward trend in the survival group,but the differences were not statistically significant(F=0.282 and 0.401,respectively,both P>0.05).The Cox regression analysis suggested INR(odds ratio(OR)=1.364,95%confidence i
作者
周学士
叶阳群
毛燕群
苏婷婷
杜合娟
过小叶
周凌霄
张英
黄利华
邱源旺
Zhou Xueshi;Ye Yangqun;Mao Yanqun;Su Tingting;Du Hejuan;Guo Xiaoye;Zhou Lingxiao;Zhang Ying;Huang Lihua;Qiu Yuanwang(Department of Hepatology,Wuxi No.5 People′s Hospital,Wuxi City,Jiangsu Province 214000,China)
出处
《中华传染病杂志》
CAS
CSCD
2020年第2期105-110,共6页
Chinese Journal of Infectious Diseases
基金
中国肝炎防治基金会(天晴肝病研究基金,TQGB20170045)
无锡市医院管理中心重点研究项目(YGZXZ1518)
无锡市医学青年人才(QNRC051)
无锡市卫生计生委科研项目(Q201831)。
关键词
抗凝血酶Ⅲ
活性
肝功能衰竭
慢加急性
预后
预测
AntithrombinⅢ
activity
Liver failure
acute-on-chronic
Prognosis
Forecasting
