凝血功能指标和血浆D-二聚体水平与消化性溃疡出血患者出血严重程度和再出血风险的相关性分析

Correlation analysis between coagulation function indexes,plasma D-dimer level and bleeding severity,rebleeding risk in patients with peptic ulcer bleeding

目的分析凝血功能指标和血浆D-二聚体(D-D)水平与消化性溃疡出血(PUB)患者出血严重程度和再出血风险的相关性。方法选择2016年2月至2020年10月本院收治的325例PUB患者作为观察组,选择同期入院接受治疗的100例单纯消化性溃疡患者作为对照组。依据PUB患者病灶出血Forrest分级结果将观察组进一步分为低危组(241例)和高危组(84例)。比较三组患者的凝血功能指标(APTT、PT)和D-D水平;比较观察组患者治疗后再出血者与未再出血者的APTT、PT及D-D水平。分析APTT、PT、D-D预测PUB患者再出血的价值。结果低危组和高危组的APTT、PT明显长于对照组,D-D水平明显高于对照组(P<0.05);高危组的APTT、PT明显长于低危组,D-D水平明显高于低危组(P<0.05)。再出血者的APTT、PT明显长于未再出血者,D-D水平明显高于未再出血者(P<0.05)。ROC曲线分析结果显示,APTT、PT、D-D在PUB患者治疗后90 d再出血预测中均具有一定价值,且三项指标联合检测的AUC明显大于单项检测(P<0.05)。结论PUB患者出血严重程度和再出血风险与APTT、PT延长和D-D高表达具有明显相关性,各指标联合检测对患者再出血具有良好的预测价值。

Objective To analyze the correlation between coagulation function indexes,plasma D-dimer(D-D)level and bleeding severity,rebleeding risk in patients with peptic ulcer bleeding(PUB).Methods A total of 325 PUB patients admitted in our hospital from February 2016 to October 2020 were selected as observation group,and 100 patients with simple peptic ulcer who were admitted in the hospital for treatment at the same period were selected as control group.According to the results of Forrest classification of focal hemorrhage in PUB patients,the observation group was further divided into low-risk group(241 cases)and high-risk group(84 cases).The coagulation function indexes(APTT,PT)and D-D level of the three groups were compared;the APTT,PT and D-D level in patients with rebleeding and those without rebleeding after treatment in the observation group were compared.The value of APTT,PT and D-D in predicting rebleeding in PUB patients was analyzed.Results The APTT and PT in the low-risk group and the high-risk group were significantly longer than those in the control group,and the level of D-D was significantly higher than that in the control group(P<0.05);the APTT and PT in the high-risk group were significantly longer than those in the low-risk group,and the level of D-D was significantly higher than that in the low-risk group(P<0.05).The APTT and PT in the rebleeding patients were significantly longer than those in the patients without rebleeding,and the D-D level was significantly higher than that in the patient without rebleeding(P<0.05).ROC curve analysis result showed that APTT,PT and D-D all had certain value in predicting rebleeding at 90 d after treatment in PUB patients,and AUC of the combined detection of the three indexes was significantly greater than that of the single detection(P<0.05).Conclusion The bleeding severity and rebleeding risk in patients with PUB are significantly correlated with prolonged APTT,PT and high expression of D-D,and the combined detection of each index has a good predictive value for rebleeding in patients.