凝血指标在判断肝硬化患者病变严重程度中的价值

The value of coagulation factors in severity categorization of hepatitis B-related liver cirrhosis

目的探讨凝血指标诊断乙型肝炎肝硬化病变严重程度的临床价值.方法收集乙型肝炎肝硬化患者58例,健康对照者20例.采用凝固法检测凝血酶原时间活动度(PTA)、活化部分凝血活酶时间及凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅸ、Ⅹ的活性,发色底物法检测抗凝血酶-Ⅲ(AT-Ⅲ),同时检测常规生化指标.结果 PTA、Ⅱ、Ⅶ、AT-Ⅲ在肝硬化Child-Pugh A、B、C间两两比较差异均有统计学意义(P<0.01).接受者操作特征曲线分析:当PTA、Ⅶ分别以64%、50%为诊断Child-Pugh B的界值时,曲线下面积分别为0.689、0.610,敏感度分别为76.9%、61.5%,特异度分别为62.2%、55.6%;以54%、39%为诊断Child-Pugh C的界值时,AUC分别为0.924、0.942,敏感度分别达80.0%、86.7%,特异度分别达88.4%、90.7%.将凝血指标、生化指标与Child-Pugh分数进行多元逐步线性回归,得到Y=15.008-0.018×PTA-0.288×胆碱酯酶+0.264×胆红素-0.988×白蛋白-0.034×Ⅶ,R2=0.871.将Y<8的患者划分为'a'级,8～10为'b'级,>10为'c'级,诊断准确率达84.5%.结论Ⅶ因子是有助于判断肝硬化病变严重程度的指标.

Objective To investigate the diagnostic value of coagulation factors in assessing the severity degree of liver cirrhosis caused by hepatitis B. Methods Fifty-eight patients with liver cirrhosis and twenty healthy persons as control were enrolled. Prothrombin time activity percentage (PTA), activated partial thromboplastin time, coagulation activity of factor Ⅱ, Ⅴ, Ⅶ, Ⅷ, Ⅸ and Ⅹ were detected with clotting assay. Antithrombin-Ⅲ (AT-Ⅲ) was detected with colorimetric assay. The biochemical markers were also detected. Results The differences of PTA, factor Ⅱ, Ⅶ and AT-Ⅲ among Child-Pugh A, B, C in patients with liver cirrhosis were statistically significant (P<0.01). Through receiver operating characteristic curve analysis, when 64% and 50% were used as cut-off values for PTA and factor Ⅶ in diagnosing Child-Pugh B, the area under the curve(AUC) was 0.689 and 0.610, the sensitivity was 76.9% and 61.5%, the specificity was 62.2% and 55.6%; when 54% and 39% were used as cut-off values for PTA and factor Ⅶ in diagnosing Child-Pugh C,the AUC was 0.924 and 0.942, the sensitivity was 80.0% and 86.7%, the specificity was 88.4% and 90.7%. Stepwise linear regression was done between Child-Pugh grade and coagulation factors. PTA, cholinesterase(Che), total bilirubin(TBil), albumin(Alb), factor Ⅶ were included in regression equation, Y=15.008-0.018×PTA-0.288×~Che+ 0.264×TBil-0.988×Alb-0.034×Ⅶ,R2=0.871. Patients whose Y was less than 8 were classified as grade “a”, between 8-10 as grade “b”, more than 10 as grade “c”, the diagnostic accuracy was 84.5%. Conclusion Coagulation factor Ⅶ may serve as a helpful marker in diagnosing the severity degree of liver cirrhosis.