肝硬化门静脉血栓患者血浆纤维蛋白原、D-二聚体水平及其对病情及预后的价值研究

The levels of plasma fibrinogen and D-dimer in cirrhosis patients with portal vein thrombosis and their value for disease condition and prognosis

目的:探讨肝硬化门静脉血栓(PVT)患者血浆纤维蛋白原(FIB)和D-二聚体水平(D-D)的变化及其对病情评估的应用价值。方法:选取127例肝硬化患者作为研究对象,其中合并PVT患者(PVT组)42例,未合并PVT患者(无PVT组)85例,比较两组患者血浆的FIB和D-D的水平变化及其对肝硬化患者病情及PVT诊断的价值。结果:两组患者血浆FIB水平随肝功能分级增加而降低,且PVT组FIB明显低于无PVT组,差异有统计学意义(P<0.05);两组患者血浆D-D随着肝功能分级的增加而升高,且PVT组D-D水平明显高于无PVT组,差异有统计学意义(P<0.05);Spearman相关分析结果显示,肝功能分级与FIB呈负相关(r=-0.703,P=0.002),与D-D呈正相关(r=0.679,P=0.005);肝硬化患者PVT的形成与FIB呈负相关(r=-0.617,P=0.011),与D-D呈正相关(r=0.658,P=0.008);进一步ROC曲线分析结果显示,以FIB=1.99g/L和D-D=1.07mg/L为临界点,联合预测的AUC、灵敏度和特异度均高于D-D与FIB单独预测,D-D与FIB联合预测AUC为0.785,其灵敏度为83.33%(35/42),特异度为78.82%(67/85)。结论:肝硬化患者血浆FIB水平降低和D-D水平升高与肝功能恶化加重密切相关,检测血浆FIB和D-D水平对PVT的诊断、预后和病情监测均有一定应用价值。

Objective:To investigate the changes of plasma fibrinogen(FIB)and D-dimer(D-D)levels in cirrhotic patients with portal vein thrombosis(PVT)and their application value in disease assessment.Methods:127 patients with liver cirrhosis were selected as the study subjects,42 patients with PVT(PVT group)and 85 patients without PVT(Non-PVT group).The changes of plasma FIB and D-D levels in the two groups were compared,and their diagnostic value for liver cirrhosis and PVT was evaluated.Results:The level of plasma FIB decreased with the increase of liver function grade in two groups,and FIB in PVT group was significantly lower than that in Non-PVT group(P<0.05).The level of plasma D-D increased with the increase of liver function grade in two groups,and the level of D-D in PVT group was significantly higher than that in Non-PVT group(P<0.05).Spearman correlation analysis showed that liver function classification was negatively correlated with FIB(r=-0.703,P=0.002),positively correlated with D-D(r=0.679,P=0.005),the formation of PVT was negatively correlated with FIB(r=-0.617,P=0.011)and positively correlated with D-D(r=0.658,P=0.008)in patients with liver cirrhosis.Further ROC curve analysis showed that the combined AUC of D-D and FIB was 0.785,and the sensitivity and specificity were 83.33%(35/42)and 78.82%(67/85)with FIB=1.99g/L and D-D=1.07mg/L as critical points.The AUC,sensitivity and specificity of combined prediction are higher than those of D-D and FIB alone.Conclusion:The decrease of plasma FIB level and the increase of D-D level in patients with liver cirrhosis are closely related to the deterioration of liver function,and detection of plasma FIB and D-D level has certain application value in the diagnosis,prognosis and disease monitoring of PVT.