摘要
目的探讨肝硬化消化道出血患者抗凝血酶Ⅲ(antithrombin-Ⅲ,AT-Ⅲ)和D-二聚体(D-dimer,D-D)水平变化及临床意义。方法选取2017年1月至2021年6月常州市第三人民医院196例肝硬化消化道出血患者为观察组,另选取同期98例肝硬化未伴消化道出血患者为对照组。检测两组患者血AT-Ⅲ、D-D水平,采用多因素Logistic回归分析肝硬化消化道出血的影响因素,比较观察组不同出血程度患者血AT-Ⅲ、D-D水平,采用Spearman法分析血AT-Ⅲ、D-D水平与出血程度的相关性。结果观察组血AT-Ⅲ水平显著低于对照组[(31.28±7.67)%vs(35.62±8.34)%],D-D水平显著高于对照组[(4.23±0.96)mg/L vs(3.68±0.87)mg/L],差异均有统计学意义(t值分别为4.441、4.775,P均<0.001)。校正Child-Pugh分级、消化道溃疡、食管静脉曲张程度、胃底静脉曲张程度后血AT-Ⅲ(OR=0.411,95%CI:0.207~0.816,P=0.021)和D-D水平(OR=3.768,95%CI:1.821~7.798,P<0.001)仍为肝硬化消化道出血的影响因素。观察组患者随出血程度增加,AT-Ⅲ呈下降趋势,D-D呈升高趋势(P均<0.05);观察组血AT-Ⅲ与出血程度呈负相关(r_(s)=-0.573,P<0.001),D-D与出血程度呈正相关(r_(s)=0.509,P<0.001)。结论肝硬化消化道出血患者AT-Ⅲ、D-D异常表达,其表达水平与患者出血程度密切相关,临床应密切监测肝硬化患者AT-Ⅲ、D-D变化,以预防消化道出血风险。
Objective To investigate the changes and clinical significance of blood antithrombinⅢ(AT-Ⅲ)and D-dimer(D-D)levels in liver cirrhosis patients with gastrointestinal bleeding.Methods A total of 196 liver cirrhosis patients with gastrointestinal bleeding in Changzhou Third People’s Hospital from January 2017 to June 2021 were selected as observation group,and 98 liver cirrhosis patients without gastrointestinal bleeding during the same period were selected as control group.Blood AT-Ⅲand D-D levels were detected in both groups.Multivariate Logistic regression was used to analyze the factors affecting gastrointestinal bleeding in liver cirrhosis.The blood AT-Ⅲand D-D levels of patients with different bleeding degrees in observation group were compared.The correlation between blood AT-Ⅲ,D-D levels and bleeding degree was analyzed by Spearman method.Results The blood AT-Ⅲlevel of patients in observation group was lower than that of control group[(31.28±7.67)%vs(35.62±8.34)%],and the D-D level was higher than that of control group[(4.23±0.96)mg/L vs(3.68±0.87)mg/L],the differences were statistically significant(t=4.441,P<0.001;t=4.775,P<0.001).After adjusting for Child-Pugh grade,peptic ulcer,esophageal varices,and gastric fundus varices,blood AT-Ⅲ(OR=0.411,95%CI:0.207~0.816,P=0.021)and D-D levels(OR=3.768,95%CI:1.821~7.798,P<0.001)were still the influencing factors of gastrointestinal bleeding in liver cirrhosis.For patients in observation group,with the increase of bleeding degree,AT-III showed a downward trend,and D-D showed an upward trend(both P<0.05).In observation group,blood AT-Ⅲwas negatively correlated with the degree of bleeding(r_(s)=-0.573,P<0.001),and D-D was positively correlated with the degree of bleeding(r_(s)=0.509,P<0.001).Conclusions The abnormal expression of AT-Ⅲand D-D in liver cirrhosis patients with gastrointestinal bleeding are closely related to the expression level and the degree of bleeding.The changes of AT-Ⅲand D-D in patients with liver cirrhosis should be closel
作者
武幸
张秀军
薛源
薛峰
徐尧
冯静云
陈菲菲
Wu Xing;Zhang Xiujun;Xue Yuan;Xue Feng;Xu Yao;Feng Jingyun;Chen Feifei(Department of Critical Care Medicine,Changzhou Third People’s Hospital,Changzhou 213001,Jiangsu Province,China)
出处
《中国肝脏病杂志（电子版）》
CAS
2023年第1期56-61,共6页
Chinese Journal of Liver Diseases：Electronic Version
基金
常州市科学技术局科技计划项目(CJ20200057)。
