血小板体积分布宽度对经颈静脉肝内门体静脉分流术后早期分流道功能障碍的预测价值  

The predictive value of platelet volume distribution width in early shunt dysfunction after transjugular intrahepatic

作　　者：李婉炎 邱文倩[1] 何丹青[1] 张婧姝[1] 甘菊芬 张超学[1] Li Wanyan;Qiu Wenqian;He Danqing;Zhang Jingshu;Gan Jufen;Zhang Chaoxue(Dept of Ultrasound Medicine ,The First Affiliated Hospital of Anhui Medical University, Hefei 230022)

机构地区：[1]安徽医科大学第一附属医院超声医学科,合肥230022

出　　处：《安徽医科大学学报》2022年第2期284-289,共6页Acta Universitatis Medicinalis Anhui

基　　金：安徽省重点研究与开发计划(编号:202004j07020031)。

摘　　要：目的探讨经颈静脉肝内门体静脉分流术(TIPS)治疗的肝硬化失代偿期患者中血小板体积分布宽度(PDW)、血小板平均体积(MPV)、D-二聚体(D-D)对早期分流道功能障碍的预测价值。方法收集经TIPS治疗半年内发生分流道功能障碍的肝硬化失代偿期患者28例,作为病例组,采用1∶2匹配对照研究,按照年龄(±2)和性别匹配56例接受TIPS治疗后半年没有发生分流道功能障碍的患者为对照组。采用SPSS 23.00软件进行单因素分析,得出有统计学意义的变量,然后进行配对设计的条件Logistic回归分析。结果有脾脏切除史、门静脉血栓史的患者和肝功能分级差的在TIPS术后易发生分流道功能障碍。血小板计数(PLT)、血小板体积分布宽度(PDW)、血小板平均体积(MPV)、D-二聚体(D-D)、纤维蛋白原单体(FDPI)在病例组和对照组之间差异有统计学意义。病例组D-D、PDW、MPV、FDPI的值高于对照组,PLT病例组低于对照组。分析得出D-D、PLT、PDW及MPV的OR值分别为1.382、0.947、2.164及3.826。受试者工作特征曲线(ROC)分析结果显示PDW、MPV、D-D曲线下面积分别为0.746、0.773、0.690。结论和超声相比,D-D、PLT、PDW能较早预测TIPS术后分流道发生功能障碍。TIPS术后随访的患者中彩色多普勒超声提示分流道功能正常的患者,密切观察D-D、PLT、PDW这些指标,对临床提示TIPS分流道功能障碍有重要的临床意义。Objective To investigate the predictive value of platelet volume distribution width(PDW),mean platelet volume(MPV),and D-dimer(D-D)on early shunt dysfunction in patients with decompensated cirrhosis treated with transjugular intrahepatic portosystemic shunt(TIPS).Methods A total of 28 patients with decompensated cirrhosis who developed shunt dysfunction within 6 months after TIPS were selected as the case group,and a 1∶2 matched control study was conducted.56 patients matched by age(±2)and gender who did not develop shunt dysfunction within 6 months after TIPS were selected as the control group.Spss23.00 software was used to conduct univariate analysis to obtain statistically significant variables,and then conditional Logistic regression analysis was conducted with paired design,with P<0.05 being statistically significant.Results Patients with a history of splenectomy,portal vein thrombosis,and those with poor liver function grade were more likely to have functional dysfunction after TIPS.Platelet count(PLT),platelet volume distribution width(PDW),mean platelet volume(MPV),D-dimer(D-D)and Fibrinogen monomer(FDPI)had statistically significant differences between the case group and the control group.The values of D-D、PDW、MPV and FDPI in the case group were higher than those in the control group,while the value of PLT in the case group was lower than that in the control group.The OR values of PDW,MPV and D-D were 2.164,3.826 and 1.382,respectively.ROC analysis results showed that the areas under PDW,MPV and D-D curves were 0.746,0.773 and 0.690,respectively.Conclusion Compared with ultrasound,D-D,PLT and PDW could predict shunt dysfunction earlier after TIPS.Patients with normal shunt function indicated by color Doppler ultrasonography in postoperative follow-up of TIPS should be closely observed for indicators such as D-D,PLT and PDW,which is of important significance for clinical indication of shunt dysfunction in TIPS.

关 键 词：经颈静脉肝内门体静脉分流术 分流道功能障碍 血小板体积分布宽度 血小板平均体积 彩色多普勒超声 

分 类 号：R575.21[医药卫生—消化系统] R657.31[医药卫生—内科学]