部分凝血因子与慢性重型肝炎预后关系的分析

Analysis of the correlation between blood coagulation factors and prognosis of chronic severe hepatitis

目的研究部分凝血因子以及凝血酶原活动度(PTA)、凝血酶原时间的国际标准化比值(INR)等检测指标与慢性重型肝炎(CSH)预后的关系。方法选择2007年6月—2008年1月我院收治的CSH患者31例,依据病情转归,分为存活组(17例)和死亡组(14例)。使用德国BE公司生产的Thrombolyzer Rack Rotor全自动凝血仪检测PTA、INR、凝血因子Ⅱ(FⅡ:C)、凝血因子Ⅴ(FⅤ:C)、凝血因子Ⅶ(FⅦ:C)及凝血因子Ⅹ(FⅩ:C)水平。选用SPSS软件对所得数据进行单因素和多因素判别分析,并对各生化指标进行相关性分析。结果CSH发生时存活组与死亡组FⅡ:C分别为31.1%±10.8%和20.4%±18.5%,FⅤ:C分别为39.4%±19.0%和14.3%±8.7%,FⅦ:C分别为21.9%±11.8%和6.4%±4.9%,FⅩ:C分别为57.2%±26.1%和42.2%±24.5%,存活组与死亡组PTA分别为28.0%±8.0%和13.5%±5.1%,INR分别为2.1±0.6和4.4±1.6。单因素分析显示FⅦ:C与CSH预后具有相关性(P<0.05);PTA、INR、FⅤ:C与CSH预后具有非常显著的相关性(P=0.00)。二分类Logistic回归分析筛选出与CSH预后相关的主要凝血指标INR和FⅤ:C,两者结合可以明显提高对CSH预后判断的阳性率(93.5%)。相关性分析显示,INR、FⅤ:C与PTA高度相关,相关系数分别为0.862、0.711。结论FⅦ:C、FⅤ:C、PTA、INR水平可作为CSH预后的判定指标,其中FⅤ:C和INR较PTA更为特异,同时测定FⅤ:C和INR水平可以更早、更准确判断CSH预后。

Objective To study the effect of some coagulation factors, prothrombin time activity（PTA）and the international normalized ratio（INR） on the prognosis of patients with chronic severe hepatitis. Methods 31 patients with chronic severe hepatitis in our department of infectious diseases were enrolled from June 2007 to January 2008. Patients were divided into improved group and death group. The serum level of PTA, INR, blood coagulation factor Ⅱ （F Ⅱ ： C）, blood coagulation factor Ⅴ （F Ⅴ ：C）, blood coagulation factor Ⅶ （F Ⅶ ：C） and blood coagulation factor Ⅹ （F Ⅹ ：C） were determined. Data were analyzed by mono-factor and multiple factors logistic regression analysis with SPSS software. The correlation was also analysed between biochemical indicators. Results The levels of F Ⅱ ：C, F V ：C, F Ⅶ ：C, F Ⅹ ：C, PTA and 1NR in improved group and death group are 31.1 % ± 10.8% vs 20.4% ± 18.5%, 39.4% ± 19.0% vs 14.3% ±8.7%, 21.9%± 11.8% vs 6.4% ±4.9%, 57.2%±26.1% vs42.2%±24.5%, 28.0% ±8.0% vs 13.5%± 5. 1% and 2.14 ± 0.6 vs 4.4 ± 1.6, respectively. The single factor analysis identified that the level of F Ⅶ ： C correlates with prognosis in chronic severe hepatitis（P〈 0.05）. The level of PTA, INR and F Ⅴ ：C correlates markedly with the prognosis. （P = 0.00）. The logistic regression discriminant analysis revealed that only INR and F Ⅴ ：C can predict the end-results of chronic severe hepatitis. Simultaneous determination of INR and F g ： C can significantly increase the accuracy for prognosis of chronic severe hepatitis. The levels of INR and F Ⅴ ： C were closely related to PTA （the correlation coefficient was 0. 862 and 0. 711 ）. Conclusion The levels of F Ⅴ ： C, F Ⅶ ： C, PTA and INR are important prognostic indicators in chronic severe hepatitis, and the levels of INR, F Ⅴ ： C are more specific than that of PTA. Simultaneous determination of F Ⅴ ：C and INR may be of help in understanding the prognosis of chronic severe hepatitis earlier and more accurately.