肝硬化上消化道出血患者异体输血治疗后APTT、PT、FIB水平变化及其与预后的关系

Changes of APTT,PT and FIB levels in patients with liver cirrhosis and upper gastrointestinal bleeding following allogeneic blood transfusion and their relationship with the prognosis

目的分析肝硬化上消化道出血患者异体输血治疗后活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)水平变化及其与预后的关系。方法选取2018年2月至2023年1月期间于郑州市第七人民医院接受输血治疗的122例肝硬化上消化道出血患者的病例资料,根据患者预后情况分为生存组(n=102)与死亡组(n=20)。收集患者一般资料以及输血治疗前及治疗1 d后血浆APTT、PT、FIB水平,分析APTT、PT、FIB水平变化与患者预后的关系。结果生存组血制品总输注量、输注比例(血浆、冷沉淀)、Child-pugh分级C级比例、休克比例、腹水比例、肝性脑病比例、C反应蛋白水平均低于死亡组,消化道首次出血比例、平均动脉压、白蛋白水平均高于死亡组,差异均有统计学意义(P<0.05);治疗后,两组APTT、PT水平均较治疗前高,FIB水平均较治疗前低,但生存组APTT、PT水平较死亡组低,FIB水平较死亡组高,差异均有统计学意义(P<0.05);经Logistic回归分析显示,Child-pugh分级为C级、消化道非首次出血、休克、腹水、肝性脑病以及APTT、PT异常升高为肝硬化上消化道出血异体输血治疗患者不良预后的危险因素,平均动脉压、FIB异常升高为患者不良预后的保护因素(P<0.05);经Pearson相关性分析显示,患者消化道非首次出血以及输血治疗后APTT、PT水平与其不良预后成正相关,平均动脉压、FIB水平与其不良预后成负相关(P<0.05)。结论肝硬化上消化道出血患者异体输血治疗预后受其消化道出血次数及治疗后APTT、PT、FIB水平影响,上述指标变化可为患者的预后评估提供重要参考价值。

Objective To analyze the changes of activated partial thromboplastin time(APTT),prothrombin time(PT)and fibrinogen(FIB)levels in patients with liver cirrhosis and upper gastrointestinal bleeding after allogeneic transfusion,and their relationship with the prognosis.Methods The medical records of 122 patients with liver cirrhosis and upper gastrointestinal bleeding who received blood transfusions in the hospital from February 2021 to December 2023 were collected retrospectively.Based on prognosis,the patients were divided into two groups:the survival group(n=102)and the death group(n=20).General patient informa⁃tion,and plasma APTT,PT and FIB levels before blood transfusion and after 1 day of treatment were collected.The relationship between changes in APTT,PT and FIB levels and the prognosis was analyzed.Results The proportions of total transfusion of blood products,blood transfusion(plasma,cryoprecipitate),Child⁃Pugh grade C,shock,ascites,hepatic encephalopathy,and C⁃reactive protein level in the survival group were lower than those in the death group.The proportion of first gastrointestinal bleeding,mean arterial pressure and albu⁃min level in the survival group were higher than in the death group(P<0.05).After treatment,APTT and PT in both groups were longer than before treatment,and FIB levels were lower than before treatment.However,APTT and PT in the survival group were shorter than those in the death group,and FIB level was higher than in the death group(P<0.05).Logistic regression analysis found that Child⁃Pugh grade C,non⁃first gastrointestinal bleeding,shock,ascites,hepatic encephalopathy,and abnormal APTT and PT were risk factors for poor prog⁃nosis in patients with liver cirrhosis and upper gastrointestinal bleeding allogeneic transfusion,while abnormal elevated mean arterial pressure and FIB were protective factors for poor prognosis(P<0.05).Pearson correla⁃tion analysis found that the levels of APTT and PT in patients with non⁃first gastrointestinal bleeding and after blood transfusion treatment are positively correlated with their poor prognosis,while mean arterial pressure and FIB level were negatively correlated with poor prognosis(P<0.05).Conclusion The prognosis of allogeneic blood transfusion in patients with upper gastrointestinal bleeding and liver cirrhosis is influenced by the frequen⁃cy of gastrointestinal bleeding and the levels of APTT,PT and FIB after treatment.Changes of the above indica⁃tors can offer valuable insight for evaluating the prognosis of patients.