Association of conventional haemostasis and coagulation tests with the risk of acute upper gastrointestinal bleeding in liver cirrhosis:a retrospective study  

传统止血和凝血试验与肝硬化急性上消化道出血的关系:一项回顾性研究

作　　者：Jing Li Xingshun Qi Han Deng Ying Peng Lichun Shao Jiaxin Ma Xiaolin Sun Hongyu Li Xiaozhong Guo 

机构地区：[1]Liver Cirrhosis Study Group,Department of Gastroenterology,General Hospital of Shenyang Military Area,Shenyang,China [2]Postgraduate College,Dalian Medical University,Dalian,China [3]Department of Gastroenterology,No.463 Hospital of Chinese PLA,Shenyang,China

出　　处：《Gastroenterology Report》2016年第4期315-319,I0003,共6页胃肠病学报道（英文）

基　　金：This study was partially supported by the grant from the National Natural Science Foundation of China(no.81500474);Natural Science Foundation of Liaoning Province(no.2015020409).

摘　　要：Objective:A retrospective study was performed to compare the difference in platelet count(PLT),prothrombin time(PT),international normalized ratio(INR),and activated partial thromboplastin time(APTT),between cirrhotic patients with and without acute upper gastrointestinal bleeding(AUGIB)or acute oesophageal variceal bleeding(AEVB).Methods:Between January 2012 and June 2014,a total of 1734 cirrhotic patients were enrolled and were classified into‘AUGIB’(n=497)and‘no AUGIB’(n=1237)groups according to their disease history.They were further divided into‘AEVB’(n=297)and‘no AEVB’(n=1259)groups according to the endoscopic findings.Additionally,178 patients with AUGIB were not assigned to either the‘AEVB’or‘no AEVB’groups due to the absence of any endoscopic findings.Results:Compared with the‘no AUGIB’group,the‘AUGIB’group had similar PLT(99.99689.90 vs.101.47683.03;P=0.734)and APTT(42.96±15.20 vs.43.77611.01;P=0.219),but significantly higher PT(17.30±5.62 vs.16.03±64.68;P<0.001)and INR(1.45±0.69 vs.1.316±0.59;P<0.001).A lower PT was independently associated with the absence of AUGIB(OR=0.968;95%CI:0.942–0.994).Compared with the‘no AEVB’group,the‘AEVB’group had significantly lower PLT(86.87662.14 vs.101.74683.62;P=0.004)and APTT(40.98±67.9 vs.43.72±10.97;P<0.001),but similar PT(16.53±3.71 vs.16.04±4.68;P=0.088)and INR(1.35±0.41 vs.1.31±0.59;P=0.225).A higher PLT was independently associated with the absence of AEVB(OR=1.004;95%CI:1.002–1.006;P=0.001).Conclusions:PLT was associated with the occurrence of portal hypertension-related bleeding in liver cirrhosis.目的:回顾性比较伴与不伴急性上消化道出血(AUGIB)或急性食管静脉曲张出血(AEVB)的肝硬化患者止血/凝血指标的差异,包括血小板计数(PLT)、凝血酶原时间(PT)、国际标准化比率(INR)和活化部分凝血活酶时间(APTT)。方法:2012年1月至2014年6月间,共计1734例肝硬化患者纳入研究。根据其病史分为AUGIB组(497例)和无AUGIB组(1237例);同时根据内镜检查结果分为AEVB组(297例)和无AEVB组(1259例),另178例AUGIB患者由于缺乏内镜资料,既未入AEVB组,也未归入无AEVB组。结果:AUGIB组与无AUGIB组患者相比,PLT(99.99±89.90 vs 101.47±83.03,P=0.734)和APTT(42.96±15.20 vs 43.77±11.01,P=0.219)的差异无统计学意义,但PT显著延长(17.30±5.62 vs 16.03±4.68,P<0.001),INR显著增高(1.45±0.69 vs 1.31±0.59,P<0.001)。PT可以独立预测AUGIB的发生,PT越低,AUGIB出现的可能性越小(OR=0.968,95%CI:0.942-0.994)。AEVB组与无AEVB组患者相比,PLT显著减少(86.87±62.14 vs 101.74±83.62,P=0.004),APTT显著缩短(40.98±7.98 vs 43.72±10.97,P<0.001),但PT(16.53±3.71 vs 16.0464.68,P=0.088)和INR(1.35±0.41 vs 1.3160.59,P=0.225)的差异则无统计学意义。PLT可独立预测AEVB的发生,PLT越高,AEVB出现的可能性越大(OR=1.004,95%CI:1.002-1.006)。结论:PLT与肝硬化患者门脉高压出血密切相关。

关 键 词：COAGULATION BLEEDING liver cirrhosis PLATELETS PROTHROMBIN 

分 类 号：R57[医药卫生—消化系统]