抗凝血酶Ⅲ在乙型肝炎肝硬化失代偿期和并发食管胃底静脉曲张破裂出血中的评估价值  

The evaluation value of antithrombinⅢin decompensated stage of hepatitis B liver cirrhosis and complicated with esophagogastric variceal bleeding

作　　者：逯世林[1] 张娜[1] 王琳[1] 甄晓光 张丽霞 薛赵群 王守桃[2] 洪峰[2] 赵婕[2] 关坤萍[1] Lu Shilin;Zhang Na;Wang Lin;Zhen Xiaoguang;Zhang Lixia;Xue Zhaoqun;Wang Shoutao;Hong Feng;Zhao Jie;Guan Kunping(Department of Clinical Laboratory,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Gastroenterology,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院检验科,太原030001 [2]山西医科大学第二医院消化科,太原030001

出　　处：《中华消化杂志》2022年第11期770-776,共7页Chinese Journal of Digestion

摘　　要：目的探讨抗凝血酶Ⅲ(AT-Ⅲ)在乙型肝炎肝硬化失代偿期和并发食管胃底静脉曲张破裂出血(EVB)患者中的评估价值。方法回顾性分析2018年1月1日至2021年12月31日于山西医科大学第二医院诊断为乙型肝炎肝硬化的193例住院患者的临床资料,包括凝血指标(AT-Ⅲ)和肝功能指标(总胆红素等),腹部超声结果(门静脉内径、门静脉血流速度),食管胃底静脉曲张发生情况。根据有无主要并发症,将193例乙型肝炎肝硬化患者分为代偿组(60例)和失代偿组(133例);根据有无EVB,将133例失代偿组患者分为未出血亚组(96例)和出血亚组(37例)。比较代偿组、失代偿组及其亚组患者以上指标水平,分析乙型肝炎肝硬化失代偿和并发EVB的独立相关因素;比较各组患者的AT-Ⅲ水平,分析AT-Ⅲ与Child-Pugh评分的关系,以及AT-Ⅲ对乙型肝炎肝硬化失代偿期及其并发EVB的诊断性能。统计学方法采用Mann-WhitneyU检验、独立样本t检验、卡方检验、多元logistic回归分析、Pearson相关分析和受试者操作特征曲线(ROC)分析。结果失代偿组患者的总胆红素水平高于代偿组,门静脉内径大于代偿组,门静脉血流速度低于代偿组[31.50μmol/L(21.90μmol/L,48.80μmol/L)比19.40μmol/L(15.00μmol/L,25.50μmol/L)、(14.31±3.53)mm比(12.57±3.83)mm、(13.39±3.49)cm/s比(15.08±4.28)cm/s],差异均有统计学意义(Z=-5.76,t=-2.78、2.40;P<0.001、=0.006、=0.018);代偿组与失代偿组患者的食管胃底静脉曲张发生率比较[40.0%(24/60)比87.2%(116/133)]差异有统计学意义(χ^(2)=64.06,P<0.001)。出血亚组患者的门静脉内径大于未出血亚组,门静脉血流速度低于未出血亚组[(15.54±4.23)mm比(13.87±3.16)mm、(12.05±3.12)cm/s比(13.85±3.51)cm/s],差异有统计学意义(t=-2.15、2.23,P=0.034、0.028)。AT-Ⅲ在代偿组、失代偿组中未出血亚组和出血亚组患者中逐渐降低,分别为(79.52±16.02)%、(63.91±19.96)%、(35.92±13.69)%,差异有�Objective To investigate the value of antithrombinⅢ(AT-Ⅲ)in evaluating patients with decompensated hepatitis B liver cirrhosis and complicated with esophagogastric variceal bleeding(EVB).Methods From January 1,2018 to December 31,2021,clinical data of 193 hospitalized patients with hepatitis B liver cirrhosis diagnosed in the Second Hospital of Shanxi Medical University were retrospectively analyzed,which included coagulation indicator(AT-Ⅲ),liver function indicators(total bilirubin,etc.),abdominal ultrasound results(portal vein diameter,portal vein blood flow velocity),and the occurrence of esophagogastric varices.According to the presence or absence of main complications,193 patients with hepatitis B liver cirrhosis were divided into compensated group(60 cases)and decompensated group(133 cases).According to the presence or absence of EVB,133 patients of decompensated group were divided into non-bleeding subgroup(96 cases)and bleeding subgroup(37 cases).The above indicators were compared among compensated group,decompensated group and their subgroups.The independent related factors of decompensated hepatitis B liver cirrhosis and EVB were analyzed.The level of AT-Ⅲof each group were compared,and the relationship between AT-Ⅲand Child-Pugh score was analyzed.The diagnostic capability of AT-Ⅲin decompensated hepatitis B liver cirrhosis and complicated with EVB were analyzed.Mann-Whitney U test,independent sample t test,chi-square test,multiple logistic regression analysis,Pearson correlation analysis and receiver operating characteristic curve(ROC)analysis were used for statistical analysis.Results The total bilirubin level of the decompensated group was higher than that of the compensated group,the portal vein diameter was larger than that of the compensated group,and the portal vein blood flow velocity was lower than that of the compensated group(31.50μmol/L(21.90μmol/L,48.80μmol/L)vs.19.40μmol/L(15.00μmol/L,25.50μmol/L);(14.31±3.53)mm vs.(12.57±3.83)mm;(13.39±3.49)cm/s vs.(15.08±4.28)cm/s)

关 键 词：抗凝血酶Ⅲ 活性 肝硬化 乙型肝炎 失代偿期 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]