D-二聚体、FDP对EVL术后早期再出血的临床诊断价值  

Clinical Diagnostic Value of D-Dimer and FDP in Early Rebleeding After EVL

作　　者：唐敬[1] 赵平[1] 谢吉良 汤国彬 Tang Jing;Zhao Ping;Xie Jiliang(Department of Gastroenterology,Guangyuan Central Hospital,Guangyuan,Sichuan 628000,China)

机构地区：[1]广元市中心医院消化内科,四川广元628000

出　　处：《四川医学》2022年第7期685-689,共5页Sichuan Medical Journal

摘　　要：目的 探讨D-二聚体(D-D)、纤维蛋白原降解产物(FDP)对食管静脉曲张套扎术(EVL)后早期再出血的临床诊断价值。方法 分析2019年12月至2022年2月于我院消化内科诊断为肝硬化伴食管静脉曲张破裂出血(EVB)并行EVL 72例患者临床资料,根据术后6周内是否再出血分为出血组和对照组。比较两组患者术前血浆D-D、FDP、血小板水平、肝硬化类型、肝功能分级等差异。单因素分析采用χ^(2)检验或Fisher确切概率法,非参数检验采用Mann-Whitney U检验,采用Logistic回归方程分析早期再出血的独立出危险因素,采用受试者工作曲线(ROC)分析上述指标的临床诊断价值。结果 单因素分析显示急诊手术、术前D-D和FDP在两组间差异有统计学意义(P<0.05),术前D-D(OR=4.411,P=0.007)、FDP(OR=0.670,P=0.042)和急诊手术(OR=0.148,P=0.021)是EVL术后早期再出血的独立危险因素,ROC曲线显示术前D-D、术前FDP、术前D-D+术前FDP的AUC分别为0.866、0.754、0.907,术前D-D的最佳截断值为2.82,灵敏度为73.7%,特异度为88.7%;术前FDP的最佳截断值为7.86,灵敏度为52.6%,特异度为92.5%;术前D-D+术前FDP的最佳截断值为0.115,灵敏度为94.7%,特异度为73.6%。结论 术前血浆D-D、FDP对EVL术后早期再出血有较好的临床诊断价值,且联合诊断价值更高。Objective To investigate clinical diagnostic values of D-Dimer(D-D) and fibrinogen degradation products(FDP) in early rebleeding after esophageal variceal ligation(EVL).Methods From December 2019 to February 2022,clinical data of 72 patients who diagnosed cirrhosis with esophageal variceal bleeding(EVB) and recived EVL in our hospital were analyzed. According to whether rebleeding within 6 weeks after operation, they were divided into bleeding group and control group. Preoperative plasma D-D,FDP,platelet concentration, liver cirrhosis types and liver function were compared between two groups. Single factor analysis used χ^(2) test or Fisher exact probability method and Mann Whitney U test were used for nonparametric test. Logistic regression equation was used to analyze independent risk factors of early rebleeding. Receiver operating characteristic curve(ROC) was used to analyze clinical diagnostic value.Results Univariate analysis showed that there were significant differences in emergency surgery, preoperative D-D and FDP between two groups(P<0.05). Preoperative D-D(OR=4.411,P=0.007),FDP(OR=0.670,P=0.042) and emergency operation(OR=0.148,P=0.021) were independent risk factors for early rebleeding after EVL. ROC curve showed that AUC of preoperative D-D,preoperative FDP and preoperative D-D + preoperative FDP were 0.866,0.754 and 0.907,respectively. Optimal cutoff value of preoperative D-D was 2.82,sensitivity was 73.7% and specificity was 88.7%. Optimal cutoff value of preoperative FDP was 7.86,sensitivity was 52.6%,and specificity was 92.5%. Optimal cutoff value of preoperative D-D + preoperative FDP was 0.115,sensitivity was 94.7%,and specificity was 73.6%.Conclusions Preoperative D-D and FDP would have good clinical diagnostic value for early rebleeding after EVL,and combined detection could be more valuable.

关 键 词：D-二聚体 纤维蛋白原降解产物 食管静脉曲张套扎术 早期再出血 肝硬化 急诊手术 

分 类 号：R575.2[医药卫生—消化系统]