凝血功能指标与肝硬化患者肝储备功能及上消化道大出血的关系

Analysis of the relationship among coagulation function indicators, liver reserve function and massive upper gastrointestinal hemorrhage in patients with liver cirrhosis

目的 目前有关凝血功能指标与肝硬化患者肝脏储备功能关系的研究鲜有报道,文中旨在分析其间关系,并进一步了解凝血功能指标对上消化道大出血的预测价值。方法 回顾性分析2020年4月至2021年6月期间上海交通大学附属苏州九龙医院收治的81例肝硬化患者(肝硬化组)以及50例慢性肝病患者(对照组)临床资料。同时,根据Child-Tureotte-Pugh(CTP)评分分级、MELD评分和近期是否出现上消化道大出血对肝硬化患者进行分组,检测并比较各组凝血功能指标,包括凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)和D-二聚体(D-D)等];分析肝硬化患者肝脏储备功能及上消化道大出血与凝血功能指标的相关性;采用受试者工作特征(ROC)曲线评估凝血功能指标对肝硬化患者上消化道大出血的预测价值。结果 肝硬化组、高MELD组、出血组PT、TT、APTT和D-D高于对照组、低MELD组、非出血组(P<0.05),FIB低于对照组、低MELD组、非出血组(P<0.05);Child C级组PT、TT、APTT和D-D高于Child A级、B级组(P<0.05),FIB低于Child A级、B级组(P<0.05),Child A级、B级组PT、TT、APTT和D-D差异均有统计学意义(P<0.05);肝硬化患者CTP分级、MELD评分及上消化道大出血与PT、TT、APTT和D-D呈正相关(P<0.05),与FIB呈负相关(P<0.05);PT、TT、APTT、FIB和D-D预测肝硬化患者上消化道大出血的AUC分别为0.762、0.800、0.824、0.840和0.851。结论 肝硬化患者存在明显凝血功能障碍,且与患者肝脏储备功能及上消化道大出血密切相关。检测凝血功能指标对肝硬化患者上消化道大出血具有一定的预测价值。

Objective The studies of the relationship between coagulation function indicators and hepatic functional reserve in patients with cirrhosis are rarely reported in the literature. This article aims to analyze this relationship and the predictive value of the coagulation function indicators on massive upper gastrointestinal hemorrhage. Methods A retrospective analysis was conducted in 81 patients with cirrhosis(cirrhosis group) and 50 patients with chronic liver disease(control group), who were admitted to Suzhou Kowloon Hospital Affiliate of Shanghai Jiao Tong University School of Medicine from April 2020 to June 2021. Meanwhile, patients with cirrhosis were divided into groups according to Child Turcotte Pugh(CTP) calculator, MELD calculator and the presence of recent upper gastrointestinal bleeding. The coagulation function indicators, including prothrombin time(PT), thrombin time(TT), activated partial thromboplastin time(APTT), fibrinogen(FIB), D-dimer(DD), were detected and compared among the groups. The correlation of hepatic functional reserve, upper gastrointestinal bleeding and coagulation function indicators in patients with cirrhosis were analyzed. Receiver operating characteristic(ROC) curve was used to evaluate the predictive value of coagulation function indicators for upper gastrointestinal bleeding in cirrhosis patients. Results The PT, TT, APTT and DD of the cirrhosis group, the high MELD group and the hemorrhage group were higher than those of the control group, the low MELD group and the non-hemorrhage group(P<0.05), and the FIB of those groups were lower than that of the control group, the low MELD group and the non-hemorrhage group(P<0.05). The PT, TT, APTT and DD of the CTP-C group were higher than those of the CTP-A and the CTP-B groups(P<0.05), and the FIB was lower than that of the CTP-A and the CTP-B groups(P<0.05). The differences in PT, TT, APTT and DD between the CTP-A group and the CTP-B group is statistically significant(P<0.05). The CTP score, the MELD score, and the presence of massive upper gastrointestinal hemorrhage in patients with cirrhosis were positively correlated with PT, TT, APTT and DD(P<0.05), and were negatively correlated with FIB(P<0.05). The AUC values of the massive upper gastrointestinal hemorrhage predicted by the PT, TT, APTT, FIB and DD in patients with cirrhosis were 0.762, 0.800, 0.824, 0.840 and 0.851 respectively. Conclusion Patients with cirrhosis have obvious coagulation dysfunction, which is closely related to the hepatic functional reserve and hemorrhage of the upper gastrointestinal tract. The detection of coagulation function indicators has a certain predictive value on upper gastrointestinal bleeding in patients with cirrhosis.