肝硬化伴上消化道出血患者外周血APRI的表达水平及临床意义

Expression level and clinical significance of APRI in peripheral blood of patients with liver cirrhosis with upper gastrointestinal bleeding

目的 探讨肝硬化并发上消化道出血患者外周血天门冬氨酸氨基转移酶(AST)和外周血血小板(PLT)比率指数(APRI)的表达水平及临床意义。方法 选取该院在2018年12月至2021年11月收治的肝硬化患者89例作为研究对象,按照是否并发上消化道出血分为出血组(44例)和非出血组(45例)。检测并比较两组患者外周血凝血酶原时间(PT)、纤维蛋白原(FIB)、清蛋白-胆红素(ALBI)及APRI水平,绘制受试者工作特征(ROC)曲线分析APRI及FIB对肝硬化患者并发上消化道出血的预测价值。比较出血组不同临床资料患者的外周血APRI表达水平。结果 出血组外周血APRI表达水平高于非出血组,而FIB水平低于非出血组,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,APRI预测肝硬化患者并发上消化道出血的曲线下面积(AUC)为0.714,灵敏度和特异度分别为71.1%和75.0%。出血组肝功能不同Child-Pugh分级患者APRI表达水平表现为A级患者<B级患者<C级患者,差异均有统计学意义(P<0.05);出血组的APRI表达水平表现为重度患者>中度患者>轻度患者,差异均有统计学意义(P<0.05);出血组6个月内死亡患者的APRI表达水平高于存活患者(P<0.05)。结论 肝硬化并发上消化道出血患者的外周血APRI表达水平明显升高,具有一定的预测价值,且外周血APRI表达水平与病情严重程度及预后有关,是潜在的疾病标志物。

Objective To investigate the expression levels and clinical significance of peripheral blood aspartate aminotransferase(AST) and the peripheral blood platelet(PLT) ratio index(APRI) in patients with liver cirrhosis complicated by upper gastrointestinal bleeding.Methods A total of 89 patients with liver cirrhosis admitted to this hospital from December 2018 to November 2021 were selected as the research objects.According to whether they were complicated with upper gastrointestinal bleeding,they were divided into bleeding group(44 cases) and non-bleeding group(45 cases).The levels of prothrombin time(PT),fibrinogen(FIB),albumin-bilirubin(ALBI) and APRI in peripheral blood of the two groups were detected and compared.The receiver operating characteristic(ROC) curve was drawn to analyze the predictive value of APRI and FIB for upper gastrointestinal bleeding in patients with liver cirrhosis.The expression levels of APRI in peripheral blood of patients with different clinical data in the bleeding group were compared.Results The expression level of APRI in the bleeding group was higher than that in the non-bleeding group,while the level of FIB was lower than that in the non-bleeding group,and the differences were statistically significant(P<0.05).ROC curve analysis showed that the area under the curve(AUC) of APRI in predicting upper gastrointestinal bleeding in patients with liver cirrhosis was 0.714,and the sensitivity and specificity were 71.1% and 75.0%,respectively.The Child-Pugh grading APRI expression level of liver function in different patients of bleeding group was as follows:grade A patients < grade B patients < grade C patients,and the differences were statistically significant(P<0.05).In the bleeding group.The expression level of APRI in the bleeding group was severe patients > moderate patients > mild patients,with statistical significance(P<0.05).In the bleeding group,the expression level of APRI in patients who died within 6 months was higher than that in patients who survived(P<0.05).Conclusion The expression level of APRI in peripheral blood of patients with liver cirrhosis complicated with upper gastrointestinal bleeding is significantly increased,which has certain predictive value.The expression of APRI in peripheral blood is related to the severity and prognosis of the disease,which is a potential disease marker.