乙型肝炎肝硬化患者血浆D-二聚体水平变化的临床意义

Clinical significance of the change in plasma D-dimer in patients with hepatitis B cirrhosis

目的评估血浆D-二聚体水平与乙型肝炎肝硬化患者病情严重程度的相关性及诊断门静脉血栓形成(PVT)的价值。方法收集2018年1月-12月就诊于解放军第五医学中心的500例乙型肝炎肝硬化患者的临床资料,根据血浆D-二聚体水平是否正常分为正常组(n=217)和升高组(n=283),比较两组患者血浆D-二聚体水平与Child-Pugh分级、MELD评分的相关性。正态分布的计量资料两组间比较采用t检验。非正态分布的计量资料两组间比较采用Mann-Whitney U检验;多组间比较及进一步两两比较均采用Kruskal-Wallis H检验。计数资料两组间比较采用χ2检验。相关性分析采用Spearman相关分析。利用受试者工作特征曲线(ROC曲线)分析评价D-二聚体水平对乙型肝炎肝硬化患者PVT的早期预警效能。结果两组患者D-二聚体水平、ALT、AST、TBil、Alb、Child-Pugh分级、MELD评分、PVT发生率比较,差异均有统计学意义(P值均<0.05)。相关性分析结果显示,两组患者血浆D-二聚体水平与Child-Pugh分级、MELD评分均呈正相关(r值分别为0.463、0.455、0.214、0.756,P值均<0.05)。共50例乙型肝炎肝硬化患者合并PVT,PVT阳性患者的D-二聚体水平明显高于PVT阴性患者[1.96(0.82~4.91)mg/L vs 0.61(0.19~1.54)mg/L,Z=-6.02,P<0.001]。ROC曲线分析结果显示,最佳诊断界值为0.76 mg/L,ROC曲线下面积和95%可信区间为0.758(0.719~0.796)。结论D-二聚体水平与乙型肝炎肝硬化患者的病情严重程度密切相关,可作为判断乙型肝炎肝硬化患者预后的指标。对于D-二聚体水平升高的患者,需警惕PVT的可能。

Objective To investigate the correlation between plasma D-dimer level and severity of hepatitis B cirrhosis and its value in the diagnosis of portal vein thrombosis(PVT).Methods A retrospective analysis was performed for the clinical data of 500 patients with hepatitis B cirrhosis who were hospitalized in The Fifth Medical Center of Chinese PLA General Hospital from January to December,2018,and according to the plasma level of D-dimer,they were divided into normal group with 217 patients and elevated group with 283 patients.The correlations of plasma D-dimer level with Child-Pugh class and Model for End-Stage Liver Disease(MELD)score were compared between the two groups.The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the Kruskal-Wallis H test was used for multiple groups comparison and further pairwise comparison.The chi-square test was used for comparison of categorical data between two groups.A Spearman correlation analysis was used to investigate correlation.The receiver operating characteristic(ROC)curve was used to evaluate the early warning performance of D-dimer level for PVT in patients with hepatitis B cirrhosis.Results There were significant differences between the two groups in D-dimer level,alanine aminotransferase,aspartate aminotransferase,total bilirubin,albumin,Child-Pugh class,MELD score,and incidence rate of PVT(all P<0.05).The correlation analysis showed that plasma D-dimer level was positively correlated with Child-Pugh class and MELD score in both groups(r=0.463,0.455,0.214,and 0.756,all P<0.05).A total of 50 patients with hepatitis B cirrhosis were found to have PVT;the patients with PVT had a significantly higher D-dimer level that those without PVT[1.96(0.82-4.91)mg/L vs 0.61(0.19-1.54)mg/L,Z=-6.02,P<0.001].The ROC curve analysis showed that D-dimer level had an area under the ROC curve of 0.758(95%confidence interval:0.719-0.796)at the optimal cut-off value of 0.76 mg/L.Conclusion Plasma D-dimer level is correlated with the severity of hepatitis B cirrhosis and can be used to predict the prognosis of patients with hepatitis B cirrhosis.The possibility of PVT should be considered in patients with an elevated D-dimer level.