上消化道出血时D-二聚体的变化及临床意义

The clinical significance of D-dimer in upper gastrointestinal hemorrhage

目的研究上消化道出血患者D-二聚体水平的变化及临床意义。方法选取2012年3月-2013年2月在我院住院的上消化道出血的131例患者的临床资料，分析D-二聚体水平在不同临床特征中的变化及其与实验室检查指标的相关性。结果131例上消化道出血患者D-二聚体平均水平为（1．41±2．57）mg／L，阳性率为48．1％（63／131）；不同病因导致的上消化道出血患者血清D-二聚体水平不同，其中食管胃底静脉曲张破裂出血、恶性肿瘤及其它病因组患者D-二聚体阳性率显著增高（P〈0．01）；周围循环衰竭、呕血及呕血伴全身症状组患者的D-二聚体阳性率较高，黑便组阳性率最低（P〈0．01）；持续和再出血患者血清D-二聚体水平显著高于无再出血的患者（P〈0．01）；死亡患者的D-二聚体阳性率显著高于好转组（P〈0．01），但与未愈组比较差异无统计学意义（P〉0．05）；D-二聚体水平与休克指数有一定相关性（P〈0．01），与入院时收缩压、脉搏、血红蛋白、红细胞计数无相关性（P〉0．05）。结论上消化道出血患者存在纤溶活动异常增强，且不同病因患者D-二聚体阳性率不同。D-二聚体水平升高可能提示机体循环血容量不足，可作为预测再出血风险的指标之一，而且提示患者预后不良。

Objective To determine whether there was a correlation between serum D-dimer and clinical characteristics in a series of patients with upper gastrointestinal hemorrhage. Methods Collect the clinical data and lab results of patients who were admitted to our hospital from March 2012 to February 2013 ,and study the clinical significance of D-dimer in upper gastrointestinal hemorrhage. Results A total of 131 patients were included in the final analysis. The average levels of D-dimer was （1.41 ~2. 57） mg/ml, the positive rate was 48. 1% （63/131）. The D-dimer positive rate of patients with esophageal variceal bleeding, cancer and rare causes were significantly higher than other groups（ P 〈 0.01 ）. Groups of periph- eral circulatory failure, hematemesis, and hematemesis with systemic symptoms had higher positive rates than other groups（P 〈 0.01 ）. The levels of D-dimer were significantly increased in patients who had persistent bleeding or rebleeding （ P 〈 0.01 ）. The positive rate of D-dimer was significantly higher in patients with adverse outcome（ P 〈 0.01 ）. A positive correlation between D-dimer and shock index was found（P 〈 0.01 ）. Conclusion Patients with upper gastrointestinal hemorrhage had abnormal enhanced fibrinolytic activity, and positive rates of D-dimer were different in different causes. Higher D-dimer plasma levels predicted circulation hypovolemia, could be a predictive indicator of risk of rebleeding and might be a helpful predictor of adverse outcome.