凝血酶原时间是慢性乙型肝炎患者肝活检纤维化程度的独立危险因素  

Prothrombin time is an independent risk factor for liver fibrosis development in patients with chronic hepatitis B

作　　者：季媛媛[1] 陈艳清[2] 程琳[2] 周海东[2] JI Yuan-yuan;CHEN Yan-qing;CHENG Lin;ZHOU Hai-dong(Shanghai Public Health Clinical Center,Shanghai 201508,China;Tenth People′s Hospital of Tongji University,Shanghai 200072,China)

机构地区：[1]上海市(复旦大学附属)公共卫生临床中心,201508 [2]同济大学附属第十人民医院

出　　处：《肝脏》2021年第4期400-402,406,共4页Chinese Hepatology

基　　金：上海市公共卫生临床中心院内课题(KY-GW-2019-59)。

摘　　要：目的发现与慢性乙型肝炎患者肝脏活组织检查(肝活检)纤维化程度具有相关性的常规指标。方法将慢性乙型肝炎患者按肝活检的纤维化程度分为较低组(N=49例)和较高组(N=37例),比较两组患者的年龄,性别,入院后24 h内血常规、肝功能、HBV血清学标志物、HBV DNA定量、凝血酶原时间、甲胎蛋白(AFP)、肝纤维化四项等指标。将有差异的指标作为变量行二元logistic回归分析寻找危险因素,并计算肝活检纤维化程度与其危险因素之间的线性关系。结果两组患者的血小板计数、HBeAg滴度、谷氨酰转肽酶、直接胆红素、球蛋白、白蛋白/球蛋白比率、前白蛋白、凝血酶原时间、肝纤维化四项指标的差异有统计学意义。Logistic回归分析提示,凝血酶原时间为肝活检纤维化程度的危险因素(P=0.001,OR=2.80,95%CI:1.53~5.10)。Spearman等级相关分析提示,凝血酶原时间和肝活检纤维化程度存在线性关系[P=0.000,相关系数(CC)=0.404]。结论慢性乙型肝炎患者的凝血酶原时间可在一定程度上反映肝活检的纤维化程度。Objective To investigate the correlation between clinical parameters and the stage of fibrosis measured by liver biopsy in patients with chronic hepatitis B(CHB).Methods A total of 87 patients with CHB were recruited and divided into 2 groups according to the stage of liver fibrosis.The clinical parameters including age,sex,and laboratory test results(blood routine,liver function,hepatitis B virus(HBV)serum makers,HBV DNA quantification,prothrombin time,alpha fetoprotein(AFP),fibrosis indexes,etc.)were compared between the 2 groups.The parameters different between the 2 groups were used as variables in a binary logistic regression analysis to investigate the risk factors.The correlation between the stage of fibrosis according to the liver pathology and the risk factor was investigated.Results There were significant differences in platelet count,HBeAg titer,glutamyl transpeptidase,direct bilirubin,globulin,albumin/globulin ratio,pre-albumin,prothrombin time and fibrosis indexes between the 2 groups.Logistic regression analysis suggested that prothrombin time was a risk factor for liver fibrosis development(P=0.001,odds ratio=2.80,95%confidence interval:1.53~5.10).The Spearman rank correlation analysis showed that there was a linear relationship between prothrombin time and liver fibrosis degree(P=0.000,CC=0.404).Conclusion Prothrombin time is an independent risk factor for liver fibrosis development in CHB patients,and has a linear relationship with the stage of fibrosis in the liver pathology.

关 键 词：凝血酶原时间 慢性乙型肝炎 肝活检 纤维化 危险因素 

分 类 号：R28[医药卫生—中药学]