血清白蛋白、凝血酶原时间对肝硬化合并上消化道出血的预测价值

Predictive Value of ALB and PT on Liver Cirrhosis Complicated with Upper Gastrointestinal Hemorrhage

【目的】探讨血清白蛋白（ALB）及凝血酶原时间（PT）对肝硬化患者并发上消化道出血的预测价值。【方法】选择2015年1月至2016年1月于本院消化内科住院并确诊为肝硬化的500例患者，根据有无合并上消化道出血分为出血组（n=236）和非出血组（n=264），并对肝硬化并上消化道出血的相关危险因素进行单因素及多因素Logistic回归分析，利用ROC曲线分析相关指标的预测价值。【结果】①单因素分析：两组ALB、PT、Child—Pugh评分、消化道出血史、腹水、食管静脉曲张、门脉高压性胃病等N素差异有统计学意义（P〈0．05）；②多因素Logistic回归分析：ALB、PT、腹水及食管静脉曲张是肝硬化并上消化道出血的独立危险因素（P〈0．05）；③ROC曲线：ALB曲线下面积为0．810，最佳阈值为16．35g／L，敏感度为0．806，特异度为0．692；PT曲线下面积为0．774，最佳阈值为22．75S，敏感度为0．722，特异度为0．860。【结论】联合检测ALB及PT水平对肝硬化并上消化道出血具有较高的预测价值。

[Objective]To investigate the predictive value of Albumin（ALB） and Prothrombin time （PT） on liver cirrhosis complicated with upper gastrointestinal hemorrhage. [Methods] Five hundred cases with liver cirrhosis were enrolled in the Department of Digestive Internal Medicine of our hospital from January 2015 to January 2016. The patients were divided into two groups： hemorrhage group（ n =236） and non hemorrhage group（ n =264）. The risk factors of cirrhosis combined with upper gastrointestinal bleeding were analyzed by single factor and multiple factors Logistic regression analysis, and the predictive value was verified on the rele vant indices by the receiver operating characteristic （ROC） curve. [Results] （1）Univariate analysis showed that ALB, PT, Child-Pugh scores, gastrointestinal hemorrhage history, esophageal varices, presence of ascites and portal hypertensive gastric mucosal lesion were statistically different between the two groups （ P 〈0.05）. （2） Multi-factor Logistic regression indicated that ALB, PT, esophageal varices and presence of ascites were the independent risk factors for the onset of upper gastrointestinal hemorrhage （ P 〈0.05）. （3） ROC curve analysis revealed that the area under the ALB curve was 0.810, the optimal threshold was 16.35 g/L, the sensitivity was 0.806 and the specificity was 0.692; The area under the PT curve was 0.774, the best threshold was 22.75 s, the sensitivity was 0.722, and the specificity was 0.860.[Conclusion] It is proved that the testing of ALB combined with PT is valuable in early predicting liver cirrhosis complicated with upper gastrointestinal hemorrhage.