凝血功能指标与肝硬化患者肝脏储备功能及上消化道出血的关系分析

Relationship between coagulation function indexes and liver reserve function,upper gastrointestinal bleeding in cirrhosis patients

目的:探讨凝血功能指标与肝硬化患者肝脏储备功能及上消化道出血的关系。方法:选取本院2018年3月~2020年6月96例肝硬化患者,比较不同肝功能(Child-Pugh分级A级(n=31)、B级(n=36)、C级(n=29))的肝硬化患者凝血功能指标活化部分凝血活酶原时间(APTT)、血浆凝血酶原时间(PT)、凝血酶时间(TT)、D-二聚体(D-D)、纤维蛋白原(FIB)水平差异,并依照患者上消化道出血情况分为出血组(n=27)与未出血(n=69),比较两组凝血功能指标差异,通过Spearman相关性分析凝血功能指标与肝硬化患者肝脏储备功能的相关性,通过Logistic回归分析凝血功能指标与上消化道出血发生的关系。结果:Child-Pugh分级A级患者凝血功能指标APTT、PT、TT时间短于B级,B级短于C级,血D-二聚体水平低于B级,B级低于C级;A级患者血FIB水平高于B级,B级高于C级;Spearman相关性分析结果显示凝血功能指标APTT、PT、TT、D-二聚体水平与Child-Pugh分级呈现正相关(r=0.305、0.294、0.328、0.503);FIB水平与Child-Pugh分级呈现负相关;Logistic回归分析结果显示Child-Pugh分级B级或C级、存在腹水、中重度食管胃底静脉曲张、PT≥16s是肝硬化患者并发上消化道出血的独立危险因素。结论:肝硬化患者凝血功能与肝脏储备功能成正相关,PT≥16s是导致肝硬化患者并发上消化道出血的独立危险因素。

Objective To explore the relationship between coagulation function indexes and liver reserve function,upper gastrointestinal bleeding in cirrhosis patients.Methods Ninety-six cirrhosis patients in the hospital from March 2018 to June 2020 were enrolled.The differences in the levels of coagulation function indexes[activated partial prothromboplastin time(APTT),plasma prothrombin time(PT),thrombin time(TT),D-dimer(D-D),fibrinogen(FIB)]among cirrhosis patients with different liver function grading[Child-Pugh grading at grade A(n=31),grade B(n=36),grade C(n=29)]were compared.According to upper gastrointestinal bleeding status,they were divided into bleeding group(n=27)and non-bleeding group(n=69).The differences of coagulation function indexes were compared between the two groups.The correlation between coagulation function indexes and liver reserve function was analyzed by Spearman correlation analysis.The relationship between coagulation function indexes and upper gastrointestinal bleeding was analyzed by Logistic regression analysis.Results APTT,PT and TT in patients with Child-Pugh grading at grade A were shorter than those at grade B,which were shorter in patients at grade B than grade C.The level of blood D-dimer in patients with Child-Pugh grading at grade A was lower than that at grade B,which was lower in patients at grade B than grade C.The level of blood FIB was the highest in patients with Child-Pugh grading at grade A,followed by grade B and grade C.The results of Spearman correlation analysis showed that levels of APTT,PT,TT and D-dimer were positively correlated with Child-Pugh grading(r=0.305,0.294,0.328,0.503),wile FIB level was negatively correlated with it.The results of Logistic regression analysis showed that Child-Pugh grading at grade B or C,ascites,moderate to severe esophagogastric varices and PT not shorter than 16s were independent risk factors of upper gastrointestinal bleeding in cirrhosis patients.Conclusion There is positive correlation between coagulation function and liver reserve function in cirrhosis patients.PT not shorter than 16s is an independent risk factor of upper gastrointestinal bleeding in cirrhosis patients.