肝硬化患者血栓调节蛋白与终末期肝病评分模型相关性分析

Analysis of the relationship between thrombomodulin changes and the score of the model for endstage liver disease in liver cirrhosis patients

目的 研究肝硬化患者血栓调节蛋白（TM）、纤溶系统指标的变化及其与终末期肝病评分模型（MELD）的关系。方法选择2008年1月至2009年12月住院肝硬化患者85例，检测TM、D-二聚体（D—dimer）、组织纤溶酶原激活物（t-PA）和组织纤溶酶原激活物抑制剂-1（PAI-1），同时检测血肌酐、血清总胆红素、凝血酶原国际标准化比值（INR），计算MELD积分。结果MELD积分为1—29（11．35±6．02）分，其中MELD≤9分40例，占47．1％，10。19分32例，占37．6％，20。29分13例，占15．3％。TM和D．dimer随肝功能恶化而升高，三者比较差异有统计学意义（P〈0．01）。TM和D．dimer与MELD积分呈正相关，相关系数分别为0．706（P〈0．01）和0．425（P〈0．01）。结论肝硬化患者的TM和D-dimer明显异常且和MELD积分呈正相关，检测TM和D．dimer有助于判断肝功能损害程度及预后。

Objective To investigate the relationship between thrombomodulin （TM）, fibrinolyfic system changes and the score of the model for end-stage liver disease （MELD） in liver cirrhosis patients. Methods Eighty-five liver cirrhosis patients admitted from January 2008 to December 2009 were included in this study. TM, D-dimer, tissue plasminogen activator（t-PA）, plasminogen activator inhibitor -1（PAI-1 ）, serum creatinine, serum total bilirubin and international normalized ratio （INR） on all patients were measured and then the score of the MELD was calculated. Results The score of the MELD was 1-29 （ 11.35 ± 6.02 ） scores. The score of the MELD ≤ 9 scores was 40 cases （47.1% ）, 10-19 scores was 32 cases （37.6%） ,20-29 scores was 13 cases （15.3%）.TM and D-dimer were progressively increased with MELD score. There was significant difference among the three groups（P 〈 0.01 ）. The levels of TM and D-dimer had positive correlation with the score of the MELD （r = 0.706 , 0.425, P 〈 0.01 ）. Conclusions The levels of TM and D-dimer have positive correlation with the score of the MELD in liver cirrhosis patients. These indices can help predicting the degree of liver function disorder and prognosis.