凝血四项及血清前白蛋白、胆碱酯酶水平与肝硬化患者肝功能分级及并发上消化道出血的相关性

Correlations of levels of four coagulation indicators,serum prealbumin and cholinesterase with liver function classification and occurrence of upper gastrointestinal bleeding in patients with cirrhosis

目的探究凝血四项[凝血酶时间(TT)、活化部分凝血酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)]、血清前白蛋白(PA)、胆碱酯酶(CHE)水平与肝硬化患者肝功能分级及其并发上消化道出血(UGB)的相关性。方法回顾性抽取2021年6月至2022年9月鹤壁煤业(集团)有限责任公司总医院收治的65例肝硬化患者为研究组,另抽取同期健康体检者79例为对照组。研究组患者根据肝功能情况对其进行Child-Pugh分级(A级21例、B级25例、C级19例),并根据是否发生UGB将其分为出血组(24例)和未出血组(41例)。采集患者血液对其行凝血四项检查和PA、CHE检查。比较对照组与研究组凝血四项和血清PA、CHE水平,比较不同肝功能患者凝血四项、PA和CHE水平,比较出血组与未出血组肝硬化患者肝功能分级、凝血四项、血清PA、CHE水平,分析肝硬化患者凝血四项、血清PA、CHE水平与肝功能分级及其并发UGB的相关性。结果研究组TT、APTT、PT高于对照组,FIB、PA和CHE水平低于对照组(P<0.05)。不同肝功能分级肝硬化患者TT、APTT、PT、FIB、PA和CHE水平比较差异有统计学意义(P<0.05),其肝功能分级与TT、APTT、PT水平呈正相关性,与FIB、PA和CHE水平呈负相关性(P<0.05)。出血组患者肝功能分级较高,TT、APTT、PT水平较高,FIB、PA和CHE水平较低(P<0.05)。多因素Logistic回归分析结果显示,肝功能分级、凝血四项、PA和CHE水平为肝硬化合并UGB的影响因素(P<0.05)。结论肝硬化患者肝功能分级与TT、APTT、PT水平呈正相关性,与FIB、PA和CHE水平呈负相关性,肝功能分级、凝血四项、PA和CHE水平均为患者发生UGB的危险因素。

ObjectiveTo investigate the correlations of levels of four coagulation indicators including thrombin time(TT),activated partial thromboplastin time(APTT),prothrombin time(PT)and fibrinogen(FIB),serum prealbumin(PA)level and cholinesterase(CHE)level with liver function classification and and occurrence of upper gastrointestinal bleeding(UGB)in patients with cirrhosis.MethodsSixty-five patients with cirrhosis admitted to General Hospital of Hebi Coal Industry(Group)Co.,Ltd.from June 2021 to September 2022 were retrospectively selected as the research group,and another 79 healthy persons who underwent physical examination during the same period were selected as the control group.Patients in the research group were classified according to Child-Pugh classification on liver function(21 cases of grade A,25 cases of grade B,and 19 cases of grade C).And they were also divided into a bleeding group(24 cases)and a non-bleeding group(41 cases)according to occurrence of UGB.Blood samples were collected from them for four coagulation indicators,PA and CHE tests.The levels of four coagulation indicators,serum PA and CHE were compared between the control group and the research group.The liver function grading,coagulation parameters,serum PA and CHE levels between the control group and the research group,among the patients with different liver function grades in the research group,and between the bleeding group and the non-bleeding group.The correlations of levels of four coagulation indicators,serum PA,and CHE with liver function grades and concurrence of UGB in patients with cirrhosis were analyzed.ResultsThe levels of TT,APTT,and PT of the research group were higher than those of the control group,while the levels of FIB,PA,and CHE were lower than those of the control group(P<0.05).There were statistically significant differences in levels of TT,APTT,PT,FIB,PA and CHE among cirrhosis patients with different liver function grades(P<0.05).The liver function grade was positively correlated with levels of TT,APTT,PT in patients with cirrhosis,moreover,it was negatively correlated with levels of FIB,PA,and CHE(P<0.05).Patients in the bleeding group had higher liver function grades,higher levels of TT,APTT,and PT,what’s more,they had lower levels of FIB,PA,and CHE compared with the non-bleeding group(P<0.05).The results of multivariate logistic regression analysis showed that liver function grade,levels of four coagulation indicators,PA level and CHE level were influencing factors for cirrhosis combined with UGB(P<0.05).ConclusionsThe liver function grade of patients with cirrhosis is positively correlated with the levels of TT,APTT and PT;and it is negatively correlated with the levels of FIB,PA and CHE.Liver function grade,four coagulation indicators,PA and CHE are all risk factors for occurrence of UGB in patients with cirrhosis.