肝硬化消化道出血患者凝血指标临床价值分析  

A Clinical Value Analysis of Coagulation Index in Patients with Upper Gastrointestinal Hemorrhage in Cirrhosis

作　　者：刘亚楠[1] 王大刚 周淳[1] 郭晶晶[1] 徐飞[1] 马建和 王雅杰 LIU Yanan;WANG Dagang;ZHOU Chun;GUO Jingjing;XU Fei;MA Jianhe;WANG Yajie(Department of Clinncal Laboratory,Beijing Ditan hospital, Capital Medical University, Beijing 100015, China)

机构地区：[1]首都医科大学附属北京地坛医院,北京100015

出　　处：《标记免疫分析与临床》2021年第11期1817-1823,1827,共8页Labeled Immunoassays and Clinical Medicine

基　　金：吴阶平医学基金会临床科研专项资助基金(编号:320.6750.19019)。

摘　　要：目的分析肝硬化患者上消化道出血相关实验室检测指标,筛选可用于临床监测并提示出血可能性、严重程度的指标。方法选取2020年10月至2021年1月本院因肝硬化上消化道出血入院患者;动态收集患者中3个月前未出血(53例)、入院第一次和出院前最后一次凝血(172例)指标,比较自身对照数据,分析其对于患者出血可能性提示作用。并根据入院时出血量将患者分为轻、中、重3组,分析凝血指标和丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、总蛋白(TP)、白蛋白(ALB)、血红蛋白(HGB)、脉搏、血压等指标,筛选出对患者出血严重程度有意义指标。选取本院同期肝硬化未发生上消化道出血患者(53例)凝血检测作为对照组,同出血前3个月患者凝血指标作比较,找出有出血危险性的提示指标。结果肝硬化患者上消化道出血3个月前凝血数据与出血入院时数据比较,提示凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原降解产物(FDP)、D-二聚体(D-dimer)低于出血入院时,活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)高于出血入院时,其中PT、Fib、TT变化具有统计学意义(P<0.05);比较患者入院和出院时凝血指标,结果提示,入院时PT、TT高于出院时,APTT、Fib、FDP、D-dimer低于出院时,其中PT、APTT、TT、Fib差异具有统计学意义(P<0.05)。在定性比较时,出血组入院时与出院时比较,提示APTT、TT、Fib差异具有统计学意义(P<0.05)。分析轻、中、重度出血患者各指标,提示TP、ALB、Fib变化同出血严重程度呈负相关,具有统计学意义(P<0.05)。肝硬化未出血组与出血组出血3个月前凝血指标比较,提示PT、APTT、TT、FDP、D-dimer未出血组低于出血组出血3个月前,Fib高于出血组出血3个月前,其中TT变化具有统计学意义。结论肝硬化伴出血临界状态患者应重点监测PT、Fib、TT指标。发生肝硬化上消化道出�Objective To analyze laboratory detection related to upper gastrointestinal bleeding in patients with cirrhosis,and to screening indicators that can be used for clinical monitoring and indicating the likelihood and severity of bleeding.Methods Patients admitted to cirrhosis and upper gastrointestinal hemorrhage from October,2020 to January,2021 were included in the study.We dynamically collected coagulation indicators such as no bleeding(53)patients before 3 months,first admission,and last coagulation(172)among patients.We then compared with patients’own control data,and analyzed the possibility of bleeding.All patients were divided into mild,moderate,and severe groups according to the bleeding volume at admission.The analysis was conducted for blood coagulation index and alanine aminotransferase(ALT),Menpartate aminotransferase(AST),total bilirubin(TBIL),total protein(TP),albumin(ALB),hemoglobin(HBG),pulse and blood pressure indexes to identify significant meaningful indicators for bleeding severity.Based on concoagulcoagulation test,patients without upper gastrointestinal hemorrhage in the same period were selected as the control group.We compared coagulation indicators in patients at 3 months before bleeding,and identified the indications for the risk of bleeding.Results Comparison of coagulation detection and bleeding admission data in the three months before upper gastrointestinal bleeding in cirrhosis patients suggested that prothrombin time(PT),thrombin time(TT),fibrinogen degradation product(FDP),D-dimer were lower than the bleeding admission group,while activated partial thromboplastin time(APTT)and fibrinogen(Fib)were above the bleeding admission group,where the PT,Fib,TT changes were statistically significant(P<0.05).For results of coagulation index at admission and discharge,the PT and TT of the admission group were higher than the discharge group,while APTT,Fib,FDP,D-dimer were below the discharge group,in which PT,APTT,TT,Fib were significant(P<0.05).In qualitative comparison,APTT,TT,and Fib were

关 键 词：肝硬化 上消化道出血 凝血检测 

分 类 号：R575.2[医药卫生—消化系统]