Des-gamma-carboxy prothrombin and alpha-fetoprotein levels as biomarkers for hepatocellular carcinoma and their correlation with radiological characteristics

BACKGROUND Alpha-fetoprotein(AFP),a commonly used biomarker for hepatocellular carcinoma(HCC),is normal in up to one-third of patients.AIM To evaluate the diagnostic performance of des-gamma-carboxy-prothrombin(DCP)alone and in combination with AFP.METHODS In this study,202 patients with radiologically proven HCC were enrolled,and their DCP and AFP levels were evaluated for their diagnostic performance.RESULTS The mean age of the enrolled patients was 58.5 years;72.0%were male.DCP was elevated in 86.6%(n=175)of all patients,100.0%(n=74)of patients with portal vein thrombus,and 87.4%(n=111)of patients with multicentric HCC.AFP was elevated in 64.3%(n=130)of all the patients,74%(n=55)of the patients with portal vein thrombus,and 71.6%(n=91)of the patients with multicentric HCC(P=0.030,0.001,and 0.015,respectively).In tumors less than 2 cm in size(n=46),DCP was increased in 32(69.5%)patients,and AFP was increased in 25(54.3%)patients(P=0.801).There was good pairing between DCP and AFP for HCCs of 2 cm size or larger(P<0.001);however,the pairing among tumors<2 cm size was not significant(P=0.210).In 69 of the patients(34.1%),only one of the tumor markers was positive;DCP was elevated alone in 57/202(28.2%)of all patients,and AFP alone was elevated in 12/202(5.9%)of the patients.The areas under receiver operating characteristic curves(AUROC)for tumors>2 cm was 0.74 for DCP and 0.59 for AFP;combining both markers resulted in an AUROC of 0.73.For tumors<2 cm,the AUROC was 0.25 for DCP and 0.40 for AFP.CONCLUSION DCP,as an individual marker,had a better diagnostic performance in many cases of HCC.Hence,DCP may replace AFP as the primary HCC biomarker.

Des-gamma-carboxy prothrombin is a promising biomarker of hepatocellular carcinoma and a predictor of complications in patients with chronic liver diseases

To the Editor: Although des-gamma-carboxy prothrombin(DCP) is considered a complementary biomarker to alpha-fetoprotein(AFP) in the diagnosis of hepatocellular carcinoma(HCC), its cut-off value has not been recommended in any guideline. This study aimed to explore the diagnostic efficacy of DCP on HCC.

Prognostic roles of preoperative α-fetoprotein and des-γ-carboxy prothrombin in hepatocellular carcinoma patients

AIM:To clarify the utility of using des-γ-carboxy prothrombin(DCP)andα-fetoprotein(AFP)levels to predict the prognosis of hepatocellular carcinoma(HCC)in patients with hepatitis B virus(HBV)and the hepatitis C virus(HCV)infections.METHODS:A total of 205 patients with HCC(105patients with HBV infection 100 patients with HCV infection)who underwent primary hepatectomy between January 2004 and May 2012 were enrolled retrospectively.Preoperative AFP and DCP levels were used to create interactive dot diagrams to predict recurrence within 2 years after hepatectomy,and cutoff levels were calculated.Patients in the HBV and HCV groups were classified into three groups:a group with low AFP and DCP levels(LL group),a group in which one of the two parameters was high and the other was low(HL group),and a group with high AFP and DCP levels(HH group).Liver function parameters,the postoperative recurrence-free survival rate,and postoperative overall survival were compared between groups.The survival curves were compared by logrank test using the Kaplan-Meier method.Multivariate analysis using a Cox forward stepwise logistic regression model was conducted for a prognosis.RESULTS:The preoperative AFP cutoff levels for recurrence within 2 years after hepatectomy in the HBV and HCV groups were 529.8 ng/m L and 60 m AU/m L,respectively;for preoperative DCP levels,the cutoff levels were 21.0 ng/m L in the HBV group and 67 m AU/m L in the HCV group.The HBV group was significantly different from the other groups in terms of vascular invasion,major hepatectomy,volume of intraoperative blood loss,and surgical duration.Significant differences were found between the LL group,the HL group,and the HH group in terms of both mean disease-free survival time(MDFST)and mean overall survival time(MOST):64.81±7.47 vs 36.63±7.62 vs 18.98±6.17mo(P=0.001)and 85.30±6.55 vs 59.44±7.87 vs46.57±11.20 mo(P=0.018).In contrast,the HCV group exhibited a significant difference in tumor size,vascular invasion,volume of intraoperative blood loss,and surgical duration;however,no significant difference was observed between the three groups in liver function parameters except for albumin levels.In the LL group,the HL group,and the HH group,the MDFST was 50.09±5.90,31.01±7.21,and 14.81±3.08 mo(log-rank test,P<0.001),respectively,and the MOST was 79.45±8.30,58.82±7.56,and 32.87±6.31 mo(log-rank test,P<0.001),respectively.CONCLUSION:In the HBV group,the prognosis was poor when either AFP or DCP levels were high.In the HCV group,the prognosis was good when either or both levels were low;however,the prognosis was poor when both levels were high.High levels of both AFP and DCP were an independent risk factor associated with tumor recurrence in the HBV and HCV groups.The relationship between tumor marker levels and prognosis was characteristic to the type of viral hepatitis.

Antibodies Against Annexin V and Prothrombin,Their Correlation with Other Anti-phospholipid Antibodies in Recurrent Pregnancy Loss

Objective To study the findings of serum antibodies against annexin V, prothrombin, ph-inositol, ph-acid, ph-ethanolamine, ph-serine, ph-glycerol, cardiolipin, and beta2-glycoprotein I and analyze the trophoblast annexin V receptors Methods Sera from 156patients aged 26-41 years with recurrent pregnancy loss （3-7 times） were investigated. Eighty-four fertile healthy women aged 24-38 years were included in a control group. ELISA methods were used for detecting a panel of sera anti-phospholipid antibodies. Immunolocalization of annexin V receptors in 143 trophoblast specimens of 156 patients was investigated by the immunofluorescence technique using Annexin V-FITC, Apoptosis and Annexin V-CY3 commercial kits. Results Positivity for anti-phospholipid antibodies mainly against ph-serine, ph- ethanolamine, and ph-inositol was found together in 80. 8%（126 out of 156 patients）, anti-prothrombin antibodies in 12% （18）, and anti-annexin V antibodies in 13. 5% （21） women. No significant levels of anti-phospholipid antibodies were found in 6 controls. Placenta immunohistopathology also exhibited some changes manifested by the presence of apoptotic and necrotic cells in trophoblast, and very few microthrombotization in some intervillous spaces. Conclusion Our detailed study demonstrated the prevalence of majority of antiphospholipid antibodies as a high risk factor for repeated reproductive failure. Very low microthrombosis in placentas could be explained by the changes of haemocoagulation properties out of uterus.

Alpha-fetoprotein and des-gamma-carboxy-prothrombin at twenty-four weeks after interferon-based therapy predict hepatocellular carcinoma development

AIM: To investigate risk factors for development of hepatocellular carcinoma(HCC) in patients with hepatitis C virus-related liver cirrhosis(LC-C).METHODS: To evaluate the relationship between clinical factors including virological response and the development of HCC in patients with LC-C treated with interferon(IFN) and ribavirin, we conducted a multicenter, retrospective study in 14 hospitals in Japan. All patients had compensated LC-C with clinical or histological data available. HCC was diagnosed by the presence of typical hypervascular characteristics on computed tomography and/or magnetic resonance imaging.RESULTS: HCC was diagnosis in 50(21.6%) of 231 LC-C patients during a median observation period of 3.8 years after IFN and ribavirin therapy. Patients who developed HCC were older(P = 0.018) and had higher serum levels of pretreatment alpha-fetoprotein(AFP)(P = 0.038). Multivariate analysis revealed the following independent risk factors for HCC development: history of treatment for HCC [P < 0.001, odds ratio(OR) = 15.27, 95%CI: 4.98-59.51], AFP levels of ≥ 10 ng/m L(P = 0.009, OR = 3.89, 95%CI: 1.38-11.94), and des-γ-carboxy prothrombin(DCP) levels of ≥ 40 m AU/mL at 24 wk after the completion of IFN and ribavirin therapy(P < 0.001, OR = 24.43, 95%CI: 4.11-238.67).CONCLUSION: We suggested that the elevation of AFP and DCP levels at 24 wk after the completion of IFN and ribavirin therapy were strongly associated with the incidence of HCC irrespective of virological response among Japanese LC-C patients.

Mesenteric vein thrombosis in a patient heterozygous for factor Ⅴ Leiden and G20210A prothrombin genotypes

Mesenteric venous thrombosis(MVT)is a rare but life threatening form of bowel ischemia.It is implicated in 6%-9% of all cases of acute mesenteric ischemia.The proportion of patients with primary(or idiopathic)MVT varies from 0% to 49%,with a decrease in frequency secondary to more recent availability of newer investigations for hypercoagulability.The presence of factor Ⅴ Leiden(FVL)and prothrombin G20210A mutations(PGM)have been well documented in these cases.However,there have been scarce case reports describing MVT in heterozygotes of both these mutations occurring simultaneously and its implications on long term management.Our case describes acute MVT in a previously asymptomatic young patient with no prior history of venous thromboembolism.The patient was found to be heterozygous for FVL and PGM and treated with lifelong anticoagulation with warfarin(goal international normalized ratio:2-3)and avoidance of hormonal contraceptives.

Prolonged prothrombin time at admission predicts poor clinical outcome in COVID-19 patients

BACKGROUND Supported by the National Natural Science Foundation of China,No.The prognostic value of coagulation disorder in coronavirus disease 2019(COVID-19)patients should be demonstrated.AIM To investigate the abnormalities of coagulation parameters in the patients with COVID-19 and their prognostic values.METHODS Consecutive patients admitted in the isolation ward of Renmin Hospital of Wuhan University from January 31 to February 5,2020 with confirmed COVID-19 were included.The primary outcomes were death and survival as of March 11.Demographics,vital signs,comorbidities and laboratory tests were collected and compared between those who died and survivors.Logistic regression analysis for prognostic factors was performed.Kaplan-Meier analysis was used to compare the estimated survival rate between patients with prolonged prothrombin time and normal prothrombin time.RESULTS The total number of patients with confirmed COVID-19 who were enrolled was 213.The median age was 62 years,and 95 patients(44.6%)were men.Fifty-one patients were critical(23.9%),79 patients were severe(37.1%)and 83 patients were moderate(39%).As of March 11,2020,99 patients were discharged(46.5%),79 patients(37.1%)stayed in the hospital and 35 patients(16.2%)died.Median time to death was 6(4-8)d,while median hospital stay was 32(22-36)d in survivors(P<0.001).More men(P=0.002)and elderly patients(P<0.001)were found in the group of those who died.The respiration rate at admission was higher in the group of those who died(P<0.001).The incidences of hypertension(P=0.028),cerebrovascular disease(P<0.001),chronic kidney disease(P=0.02)and chronic obstructive pulmonary disease(P<0.001)were higher in the group of those who died.Platelet count was decreased in the group of those who died(P=0.002)whereas prothrombin time(P<0.001),activated partial thromboplastin time(P=0.033),concentration of D-dimer(P<0.001)and fibrin degradation products(P<0.001)were increased in the group of those who died.Prothrombin time[odds ratio(OR):2.19,P=0.004],respiration rate(OR:1.223,P<0.001),age(OR:1.074,P<0.001)and fibrin degradation products concentration(OR:1.02,P=0.014)were predictors of death.The survival rate was significantly lower in patients with prolonge CONCLUSION Prothrombin time,concentration of fibrin degradation products,respiration rate and age were predictive factors for clinical outcomes of COVID-19 patients.

Portal vein thrombosis following percutaneous transhepatic cholangiography-An unusual presentation of Prothrombin (Factor Ⅱ) gene mutation

Portal vein thrombosis is an uncommonly reported complication of percutaneous transhepatic cholangiography (PTC). A thorough review of the available literature shows no reported cases. In this case, a 29 year old female presented on two separate occasions with portal vein thrombosis following PTC without drain placement. This unusual complication of image guided percutaneous biliary access is unreported in the literature and prompted evaluation of the patient's coagulation parameters. A thrombophilia screen demonstrated a mutation in the Prothrombin (Factor Ⅱ) gene. A thorough literature review shows no reported cases of portal vein thrombosis following percutaneous biliary access, is an unusual complication, and should raise suspicion of an underlying pro-coagulant state.

Superiority of Prothrombin Complex Concentrate versus Frozen Fresh Plasma in Cardiology Patients with Warfarin Intoxication–Observational Study

Objective: The objective of this study was to analyse the reversibility of the anticoagulant effect of warfarin by comparing prothrombin complex concentrate (PCC) versus frozen fresh plasma (FFP) in cardiology patients with serious warfarin intoxication. Methods: This was an observational and retrospective study comprising 67 patients (18 in group I [PCC] and 49 in group II [FFP]). The primary endpoint was the reversal of anticoagulant effect of warfarin after 2 and 24 hours of PCC or FFP administration. Comparisons between the groups were made using T-test and Q-square. Multivariate analyses were conducted using logistic regression, and the results were considered significant when p Results: The medium dose used was 27.6 UI/kg of PCC and 14.5 ml/kg of FFP. Significant differences were observed between groups I and II in the INR reversibility measurements after 2 hours (33.3% vs. 6.1%, p = 0.001) and 24 hours (38.9% vs. 12.2%, p = 0.009) as well as in the occurrence of pulmonary edema (5.6% vs. 42.9%, OR = 11.10, p = 0.04). The AUC for PCC was 0.891 (CI 95% [0.72 - 1.0]), and for FFP, it was 0.291 (CI 95% [0.09 - 0.49]). Conclusions: PCC is better than FFP treatment in reversing the warfarin intoxication after 2 and 24 hours of administration. Furthermore, PCC showed lower pulmonary edema in cardiology patients.

Effects of Chloroquine and Naphthoquinone on Prothrombin Time and Activated Partial Thromboplastin Time of Swiss Mice

Concerns on the coagulation variables, Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) which are part of coagulation parameters used in assessing haemostatsis in haematology, led to the study of the effects of naphthoquinone and chloroquine on the PT and APTT of mice infected with Plasmodium berghei, and treated with graded concentrations of chloroquine and naphthoquinone. Using brain thromboplastin with calcium and rabbit brain cephalosporin ad kaolin respectively the experiment aimed at demonstrating the effect of chloroquine with purity of 99.79% and naphthoquinone with purity of 97.00%, upon a three-day intraperitoneal administration at concentrations of 0.1 mg/kg, 0.5 mg/kg, 1.0 mg/kg and 2.0 mg/kg. Result showed that the APTT and PT of naphthoquinone at 2.0 mg/kg, were 196.67 seconds, and 67.63 seconds respectively, while the APTT and PT of chloroquine were 3.63 seconds and 1.40 seconds respectively for the same concentration. Also, naphthoquinone showed lower APTT but sustained PT at concentrations below 1.50 mg/kg whereas both APTT and PT increased from concentrations above 1.50 mg/kg. On the other hand chloroquine showed a lowered APTT between 0.00 to 0.15 mg/kg while PT was sustained, but both APTT and PT increased from concentration of 0.15 mg/kg gradually. This study conclusively showed that chloroquine has a shorter APTT and PT than naphthoquinones, even though they elicited similar actions. Apart from this, naphthoquinone and chloroquine belonging to the same family, naphthoquinone could be more toxic than chloroquine at the dosages equivalent to 1.50 mg/kg, therefore, any administration of naphthoquinone above this dosage should be closely monitored to avoid any form of danger to the patient.

Relationship between Methylenetetrahydrofolate Reductase (C677T), Factor V Leiden (G1691A), Prothrombin Mutation (G20210A) and Severe Preeclampsia in a Brazilian Population

Objectives: To better understand the etiologic factors that can influence preeclampsia, we inves- tigated hereditary factors for thrombosis, FV Leiden, F II 20210A mutation and the polymorphism C677T of the MTHFR, as singly and as in association, in a group of women from Ceará state-Northeast Brazil with severe preeclampsia. Material and Methods: We conducted a case-control study. 101 cases of severe preeclampsia were recruited from School Maternity Assis Chateaubriand, a reference Maternity of State of Ceará, Brazil, from December 2009 to December 2010. For clinical correlations, women were interrogated about fetal low weight (less than2500 grams) and fetal loss in previous pregnancies. Low weight, fetal loss and necessity of neonatal intensive care unit (neonatal ICU) related to current pregnancy were registered. 245 healthy voluntary women were recruited from the blood bank donors to verify the frequency of FV Leiden, FII and MTHFR as a control group. The study was approved by the Committee on Ethics in Human Research of Maternidade Escola Assis Chateubriand and all individuals gave their informed consent to participate in the study. Standard veinipuncture, with EDTA as anticoagulant, was used to collect blood samples. Genomic DNA was extracted, soon after, using a salting out method. Agarose gel electrophoresis with ethidium bromide staining was performed to ensure the quality of DNA extraction. Results: The frequencies of FV Leiden and FII mutation carrier were 0.99% (1/101) for both factors in the preeclampsia patients and 1.86% (4/214) and 0.93% (2/214), respectively, in control group. All mutates were heterozygous and concomitance of both mutations was not found. The genotype distribution of the MTHFR C677T in the patients and controls frequencies was in Hardy-Weinberg equilibrium (p ≤ 0.05). No statistical difference was observed between cases and controls in MTHFR genotypes or alleles. Conclusions: The FV Leiden, FII G20210A mutation and MTHFR C677T were not risks for preeclampsia development. FV Leiden and FII G20210A mutations had low frequency in the population studied, which may justify the absence of association.

Usefulness of serum des-γ-carboxy prothrombin in detection of hepatocellular carcinoma

AIM: To evaluate whether DCP is better than AFP for differentiating HCC from nonmalignant liver disease and further evaluate the usefulness of DCP in early diagnosis of small HCC.METHODS: Serum DCP and AFP levels were determined in 127 patients. Among these patients, 32 were with noncirrhotic chronic hepatitis, 34 were with compensated cirrhosis, and 61 were with HCC. The cut-off value for the DCP and AFP were set as 40 mAU/mL and 20 ng/mL,respectively. To compare the diagnostic value of DCP and AFP in distinguishing HCC from nonmalignant chronic liver disease, receiver operating characteristic (ROC) curves were constructed for each assay.RESULTS: The accuracy, sensitivity, and specificity of DCP were higher than AFP in detecting HCC (81.9%, 77%,and 86.4% vs 68.5%, 59%, and 77.3%, respectively).The area under the ROC (AUROC) curves revealed that DCP had a better accuracy than AFP in diagnosis of HCC (0.85 [95%CT, 0.78-0.91] vs 0.73 [95%CI, 0.65-0.81],P = 0.013). In 39 patients with solitary HCC, the positive rates of DCP were 100% in patients with tumor size larger than 3 cm, 66.7% in patients with tumor size 2-3 cm and50% in patients with tumor size less than 2 cm. The positive rates of AFP in patients with tumor size larger than 3 cm, 2-3 cm and less than 2 cm were 55.6%, 50%,and 33.3%, respectively. The median level of DCP in HCC patients with tumor size larger than 3 cm was significantly higher than those with tumor size 2-3 cm and those with the size of less than 2 cm.CONCLUSION: Our study indicates that DCP has a better diagnostic value than AFP in differentiating HCC from nonmalignant chronic liver disease. DCP has not only a stronger correlation with HCC than AFP in tumor size but also more effectiveness than AFP in detecting small size of HCC.

Des-gamma-carboxy prothrombin as an important prognostic indicator in patients with small hepatocellular carcinoma

AIM:To clarify the effect of a high des-gamma-carboxy prothrombin (DCP) level on the invasiveness and prognosis of small hepatocellular carcinoma. METHODS: Among 142 consecutive patients with known DCP levels, who underwent hepatectomy because of hepatocellular carcinoma, 85 patients met the criteria for small hepatocellular carcinoma, i.e. one ≤ 5 cm sized single tumor or no more than three ≤ 3 cm sized tumors. RESULTS: The overall survival rate of the 142 patients was 92.1% for 1 year, 69.6% for 3 years, and 56.9% for 5 years. Multivariate analysis showed that microscopic vascular invasion (P = 0.03) and serum DCP ≥ 400 mAU/mL (P = 0.02) were independent prognostic factors. In the group of patients who met the criteria for small hepatocellular carcinoma, DCP ≥ 400 mAU/mL was found to be an independent prognostic factor for recurrence-free (P = 0.02) and overall survival (P = 0.0005). In patients who did not meet the criteria, the presence of vascular invasion was an independent factor for recurrence-free (P = 0.02) and overall survivals (P = 0.01). In 75% of patients with small hepatocellular carcinoma and high DCP levels, recurrence occurred extrahepatically. CONCLUSION: For small hepatocellular carcinoma, a high preoperative DCP level appears indicative fortumor recurrence. Because many patients with a high preoperative DCP level develop extrahepatic recurrence, it is necessary to screen the whole body.

Increased fibrosis progression rates in hepatitis C patients carrying the prothrombin G20210A mutation

AIM: To examine whether hepatitis C virus (HCV)-infected patients who carry hypercoagulable mutationssuffer from increased rates of liver fi brosis. METHODS: We analyzed DNA samples of 168 HCV patients for three common hypercoagulable gene mutations: prothrombin 20210 (PT20210), factor V Leiden (FV Leiden) and methylene tetrahydrofolate reductase (MTHFR). The patients were consecutively recruited as part of the prospective "Fibroscore Study" in France. The effect of the various mutations on the rate of fi-brosis was analyzed statistically and was correlated with epidemiological, clinical and biochemical data such as grade and stage of liver biopsies, patients' risk factors for liver cirrhosis, and timing of infection. RESULTS: Fifty two of the patients were categorized as "fast fi brosers" and 116 as "slow fi brosers"; 13% of the "fast fi brosers" carried the PT20210 mutation as compared with 5.5% of the "slow fi brosers", with an odds ratio of 4.76 (P = 0.033; 95% CI: 1.13-19.99) for "fast" liver fibrosis. Carriage of MTHFR or FV Leiden mutations was not associated with enhanced liver fi brosis. CONCLUSION: Carriage of the PT20210 mutation is related to an increased rate of liver fi brosis in HCV patients.

Prevalence of factor V Leiden and prothrombin G20210A in patients with gastric cancer

瞄准：分析二个最普通的 thrombophilic 变化，第五因子 Leiden 和凝血素 G20210A 的流行，在有胃的癌症的病人。方法：有主要的胃的癌和 130 个健康题目，的 121 个病人可比较好久并且性别，被调查。第五因子 Leiden 被由等位基因特定的 PCR 使用聚合酶链反应和限制酶消化，和凝血素 G20210A 基因变化检测。结果：在 121 个癌症病人之中，第五因子 Leiden 在 4 种情况中被发现(GA 遗传型：3.3%) 并且在 10 种情况中的凝血素 G20210A (GA 遗传型：8.3%) 。130 个控制题目，第五因子 Leiden 在 6 种情况中被检测(GA 遗传型：4.6%) 并且在 8 种情况中的凝血素 G20210A (GA 遗传型：6.1%) 。两个变化的两倍异质接合的搬运人都没在任何一个组被发现。第五因子 Leiden 和凝血素 G20210A 变体的流行不在癌症病人和健康题目之间是统计上不同的。结论：我们的学习建议在胃的癌症， thrombophilic 癌症状态的风险因素在上获得而非在一个基因基础和那凝血素上， G20210A 不似乎是在胃的癌症的一个余因子致病。

乙肝相关慢加急性肝衰竭患者6个月预后影响因素分析及模型构建

目的分析乙肝相关慢加急性肝衰竭(Hepatitis B virus associated chronic acute liver failure,HBV-ACLF)患者6个月预后影响因素及预后模型的建立。方法以2017年5月-2022年5月新疆医科大学第一附属医院感染中心收治的131例HBV-ACLF患者为研究对象。随访6个月,根据患者预后结果分为死亡组(n=60)和存活组(n=71)。收集患者血常规、肝功能、肾功能及血气指标,采用Logistics回归分析筛选影响HBV-ACLF患者6个月预后的因素,并将筛选的因素使用R 4.3.0软件进行绘制列线图预测模型,绘制校准曲线和受试者工作特征曲线(Receiver operating characteristic,ROC)拟合度及预测效能评估,根据决策曲线评估预测模型的临床适用性。结果二元Logistics回归分析发现,血小板计数、白蛋白及凝血酶原时间是影响HBVACLF患者6个月预后的重要因素,建立的预后模型区分度和校准能力较好。自发性腹膜炎在存活组和死亡组HBV-ACLF患者并发症中占比均最高。结论通过白蛋白,血小板计数和凝血酶原时间建立的预测模型对HBV-ACLF患者6个月预后有较好的预测价值。

下肢静脉曲张术后延续性干预的效果及复发影响因素分析

目的探讨下肢静脉曲张术后延续性干预的效果及复发影响因素。方法选择2020年3月至2022年9月收治的下肢静脉曲张并行手术治疗的患者100例,随机分为观察组和对照组各50例,对照组行常规干预,观察组使用延续性干预,对比2组复发情况、凝血功能及生活质量。根据患者术后12个月是否复发分为复发组42例和未复发组58例,收集2组一般资料,应用多因素Logistic回归分析术后复发的影响因素。结果观察组术后6、9、12个月复发率低于对照组(P<0.05,P<0.01);观察组凝血酶时间、凝血酶原时间及活化部分凝血酶原时间均长于对照组(P<0.05);观察组躯体、心理、角色、社会四个维度评分均高于对照组(P<0.05)。年龄≥60岁、体质量指数、文化程度、静脉曲张年限、凝血功能以及延续性干预均是下肢静脉曲张术后复发的影响因素(P<0.05,P<0.01)。结论年龄、体质量指数、文化程度、静脉曲张年限及凝血功能是下肢静脉曲张术后复发影响因素,术后应用延续性干预能降低复发率,提高患者生活质量。

急性病毒性肝炎患者凝血四项、血脂指标水平及其预后评估价值分析

目的分析急性病毒性肝炎(AVH)患者凝血四项、血脂指标水平及其评估预后的价值。方法选取2020年1月1日至2022年1月31日收治的300例AVH作为研究组,300例体检健康人员作为对照组。比较2组一般资料、凝血四项[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、血脂指标[总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)]。研究组均行常规抗病毒、护肝治疗,比较研究组不同治疗效果患者治疗前后凝血四项、血脂指标,并分析治疗前凝血四项、血脂指标与治疗效果的相关性及预测治疗效果的价值。结果研究组外周血PT、APTT、TT长于对照组,FIB、TC、HDL-C、LDL-C水平低于对照组,TG水平高于对照组(P<0.01)。研究组治疗效果为无效患者治疗前、治疗后外周血PT、APTT、TT长于有效、显效患者,有效患者长于显效患者(P<0.05);FIB、TC、HDL-C、LDL-C水平低于有效、显效患者,有效患者低于显效患者,TG水平高于有效、显效患者,有效患者高于显效患者(P<0.05);研究组治疗后外周血PT、APTT、TT、TG水平与治疗效果呈负相关,FIB、TC、HDL-C、LDL-C与治疗效果呈正相关(P<0.05,P<0.01);治疗前凝血四项与血脂指标联合预测AVH患者治疗效果的曲线下面积为0.937(95%CI为0.903,0.962),预测敏感度、特异度分别为85.21%、88.61%,明显优于凝血四项、血脂指标单独预测(P<0.01)。结论AVH患者凝血四项、血脂指标存在明显异常,且治疗前凝血四项与血脂指标联合检测在预测治疗效果方面具有较高价值。

白蛋白和凝血酶原时间比率对肝癌手术预后的预测价值

目的探讨肝癌患者行肝切除术前白蛋白和凝血酶原时间比率(APT)对预后的预测价值。方法选择2014年1月至2020年12月在广西医科大学第一附属医院治疗的272例经临床病理证实的肝细胞癌患者。建立ROC曲线,确定最佳截断值,将患者分为高低APT水平组,通过COX分析筛选肝癌患者的预测术后预后因素,K-M曲线分析APT对肝癌术后预后的影响。结果根据最佳截断值2.981,将APT分成高低水平组,曲线下面积为0.751(P<0.05)。总胆红素、凝血酶原时间(PT)、甲胎蛋白(AFP)等与APT水平分组均无明显相关(P>0.05),APT水平与肝癌患者预后呈正相关(P<0.05)。COX回归分析显示,总胆红素、AFP、肝硬化等与肝癌患者预后无关,而高低APT水平与肝癌预后相关[Exp(B)=4.32,95%CI:1.824~10.27,P=0.001]。结论APT是肝癌手术预后有效的预测指标。

不同负压引流方式联合氨甲环酸对颈椎后路单开门手术病人失血量、引流量及并发症的影响

目的探究不同负压引流方式联合氨甲环酸对颈椎后路单开门手术的多节段脊髓型颈椎病病人失血量、引流量及并发症的影响。方法按照研究目标设定的纳入、排除标准,将2018年10月至2020年10月沧州中西医结合医院接受颈椎后路单开门手术的多节段脊髓型颈椎病病人182例作为研究对象进行回顾性研究,根据负压引流情况分为A组(持续负压引流联合氨甲环酸,46例)、B组(间断负压引流联合氨甲环酸,46例)、C组(持续负压引流,不使用氨甲环酸,45例)及D组(间断负压引流,不使用氨甲环酸,45例)。对比四组病人手术时间、总失血量、术后引流量、术后72 h血红蛋白水平,生化指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fib)],术后疼痛视觉模拟评分(VAS)及日本骨科协会评估治疗分数(JOA)评分。结果手术后,四组手术时间、总失血量比较差异无统计学意义(P>0.05),四组术后24 h引流量[A组(191.21±22.38)mL、B组(175.34±17.85)mL、C组(205.62±20.78)mL、D组(210.43±20.14)mL]、术后隐性失血量[A组(275.37±30.12)mL、B组(251.42±26.12)mL、C组(321.47±35.62)mL、D组(296.78±32.14)mL]、引流管留置时间[A组(1.85±0.51)d、B组(1.45±0.42)d、C组(2.32±0.65)d、D组(2.78±0.78)d]比较差异有统计学意义(P<0.05),其中B组最优,其次为A组。四组术后72 h血红蛋白水平[A组(112.43±12.57)g/L、B组(120.53±17.85)g/L、C组(103.47±10.78)g/L、D组(102.58±11.12)g/L]均明显降低(P<0.05),但是B组下降最少,其次为A组。四组血清APTT、PT、Fib水平差值比较差异有统计学意义(P<0.05),其中A组各指标变化最明显,B组血清APTT水平变化最小;四组VAS评分与JOA评分比较差异无统计学意义(P>0.05);四组发热、脑脊液漏、血肿压迫脊髓、下肢深静脉血栓、心血管事件等并发症发生情况比较差异无统计学意义(P>0.05)。结论颈椎后路单开门手术中应用间断负压引流联合氨甲环酸利于手术时间缩短,并减少术后引流量及隐性失血量,改善血红蛋白水平。