急性上消化道出血患者D-D、AT-Ⅲ与幽门螺杆菌感染检测意义

Clinical significance of D-dimer,antithrombinⅢ,and Helicobacter pylori infection in acute upper gastrointestinal bleeding

背景尽管近年来,消化道出血(acute upper gastrointestinal bleeding,AUGIB)患病人数有所下降,但其整体病死率仍高达5%-11%.机体凝血-纤溶过程中的物质D-二聚体(D-dimer,D-D)、抗凝血酶Ⅲ(antithrombinⅢ,AT-Ⅲ)及幽门螺杆菌(Helicobacter pylori,H.pylori)与肝硬化患者消化道出血有关,但关于其与AUGIB危险分层的研究较少.目的探究急性上AUGIB患者D-D、AT-Ⅲ与H.pylori感染检测意义.方法选取2019-06/2023-10我院120例AUGIB患者作为观察组,另选取同期健康体检者120例作为对照组.比较两组D-D、AT-Ⅲ、H.pylori感染率,并比较不同危险分层患者临床资料及、D-D、AT-Ⅲ与H.pylori感染情况,分析AUGIB危险分层的影响因素,以受试者工作特征曲线评价D-D、AT-Ⅲ与H.pylori感染对中高危AUGIB的诊断价值.结果观察组血浆D-D水平及H.pylori感染率高于对照组,AT-Ⅲ水平低于对照组(P<0.05);中高危患者年龄、血浆D-D水平及H.pylori感染率高于低危患者,血红蛋白及AT-Ⅲ水平低于低危患者(P<0.05),Logistic回归分析结果显示,年龄、血红蛋白、D-D、AT-Ⅲ及H.pylori感染均为AUGIB危险分层的独立影响因素(P<0.05);D-D、AT-Ⅲ与H.pylori感染单独预测诊断中高危AUGIB的AUC值分别是0.813、0.776、0.711,三者联合预测诊断AUC值为0.933,明显大于各指标单独诊断,最佳敏感度及特异度分别是85.29、91.86%.结论D-D、AT-Ⅲ、H.pylori感染均与AUGIB的发生及危险分层有关,临床对其进行检测,可诊断AUGIB患者危险分层.

BACKGROUND Although the number of patients with acute upper gastro-intestinal bleeding(AUGIB)has decreased in recent years,its overall mortality rate is still as high as 5%-11%.D-dimer(D-D),antithrombinⅢ(AT-Ⅲ),and Helicobacter pylori(H.pylori)infection have been associated with gastrointestinal bleeding in patients with cirrhosis,but there is little research on their relationship with risk stratification of AUGIB.AIM To assess the clinical significance of D-D,AT-Ⅲ,and H.pylori infection detection in patients with AUGIB.METHODS A total of 120 AUGIB patients treated at our hospital from June 2019 to October 2023 were selected as an observation group,and 120 healthy subjects were selected during the same period as a control group.Clinical data,D-D,AT-Ⅲ,and H.pylori infection were compared between the two groups.The relationship of D-D,AT-Ⅲ,and H.pylori infection with AUGIB was analyzed.D-D,AT-Ⅲ,and H.pylori infection in patients with different risk of AUGIB were compared,and their diagnostic value for medium-high-risk AUGIB was evaluated by receiver operating characteristic(ROC)curve analysis.RESULTS Age,plasma D-D level,and H.pylori infection rate in the observation group were significantly higher than those of the control group,while hemoglobin and AT-Ⅲlevels were significantly lower than those of the control group(P<0.05).Logistic regression analysis showed that after adjusting for age,hemoglobin,and other factors,D-D,AT-Ⅲ,and H.pylori infection were still related to AUGIB(P<0.05).Plasma D-D levels and H.pylori infection rate in low-risk patients were significantly lower than those of medium-risk patients,and AT-Ⅲlevels were significantly higher than those of medium-risk patients(P<0.05).However,plasma D-D levels and H.pylori infection rate in medium-risk patients were significantly lower than those of high-risk patients,and AT-Ⅲlevels were significantly higher than those of high-risk patients(P<0.05).The area under the ROC curve(AUC)values of D-D,AT-Ⅲ,and H.pylori infection alone for predicting high-risk AUGIB were 0.813,0.776,and 0.711,respectively.The AUC value of their combination for prediction of high-risk AUGIB was 0.933,significantly greater than that of each of them alone,with the best sensitivity and specificity at 85.29%and 91.86%,respectively.CONCLUSION D-D,AT-Ⅲ,and H.pylori infection are all associated with the occurrence and risk stratification of AUGIB.Clinical detection of these factors can help stratify patients with AUGIB.