凝血功能预测肝硬化伴食管静脉曲张破裂出血患者内镜术后早期再出血的效能分析

Predictive efficiency of coagulation function for early rebleeding in patients with cirrhosis and esophageal variceal bleeding after endoscopy

目的:分析凝血功能预测肝硬化伴食管静脉曲张破裂出血患者内镜术后早期再出血的效能。方法:将2021年6月至2023年6月我院收治的64例肝硬化伴食管静脉曲张破裂出血患者纳入研究。对所有患者行内镜手术,并根据术后是否发生再出血事件进行分组,将发生再出血事件的患者纳入出血组(31例),将未发生出血事件的患者纳入未出血组(33例)。对比两组患者术后1 d、5 d、7 d的凝血四项指标凝血酶时间(Thrombin time,TT)、凝血酶原时间(Prothrombin time,PT)、活化部分凝血活酶时间(Activated partial thromboplastin time,APTT)、纤维蛋白原(Fibrinogen,FIB)。并使用受试者工作特征曲线分析术后1 d患者PT、APTT、TT、FIB对内镜术后早期再出血的预测价值。结果:术后1 d,出血组患者PT、APTT、TT水平高于未出血组,FIB低于未出血组(P<0.05);术后5 d,出血组患者PT、APTT、TT水平高于未出血组,FIB低于未出血组(P<0.05);术后7 d,出血组患者PT、TT水平高于未出血组,FIB水平低于未出血组(P<0.05),两组患者APTT水平差异不明显(P>0.05)。经ROC分析,PT、APTT、TT、FIB对内镜术后早期再出血的下曲线面积分别为0.679、0.761、0.754、0.743,敏感度分别为72.73%、66.67%、75.00%、79.17%,特异性分别为64.29%、75.00%、72.22%、70.00%(P<0.05)。结论:凝血功能对肝硬化伴食管静脉曲张破裂出血患者内镜术后早期再出血具有预测价值,可用于早期评估患者的再出血风险。

Objective:To analyze the predictive efficiency of coagulation function for early rebleeding in patients with cirrhosis and esophageal variceal bleeding after endoscopy.Methods:A total of 64 patients with cirrhosis and esophageal variceal bleeding undergoing endoscopy in the hospital were enrolled between June 2021 and June 2023.According to presence or absence of postoperative rebleeding,they were divided into bleeding group(31 cases)and non-bleeding group(33 cases).The coagulation four indices[thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB)]were compared between the two groups at 1 day,5 days and 7 days after surgery,and their predictive value for early rebleeding after endoscopy was analyzed by receiver operating characteristic(ROC)curves at 1 day after surgery.Results:At 1 day after surgery,PT,APTT and TT in bleeding group were longer than those in non-bleeding group,and FIB level was lower than that in non-bleeding group(P<0.05).At 5 days after surgery,PT,APTT and TT in bleeding group were longer than those in non-bleeding group,and FIB level was lower than that in non-bleeding group(P<0.05).At 7 days after surgery,PT and TT in bleeding group were longer than those in non-bleeding group,FIB level was lower than that in nonbleeding group(P<0.05),but there was no significant difference in APTT between the two groups(P>0.05).ROC curves analysis showed that area under the curve(AUC),sensitivity and specificity of PT,APTT,TT and FIB for predicting early rebleeding after endoscopy were(0.679,0.761,0.754,0.743),(72.73%,66.67%,75.00%,79.17%)and(64.29%,75.00%,72.22%,70.00%),respectively(P<0.05).Conclusion:Coagulation function has predictive value for early rebleeding in patients with cirrhosis and esophageal variceal bleeding after endoscopy,which can be applied in early evaluation of rebleeding risk.