乙型肝炎肝硬化上消化道出血患者血清TPO、YKL-40水平变化及对DIC发生风险的指导意义  

Changes of serum TPO and YKL-40 levels in patients with upper gastrointestinal hemorrhage in hepatitis B cirrhosis and their guiding significance for the risk of DIC

作　　者：赵润玲 ZHAO Runling(Department of Blood Transfusion,the Sixth Division Hospital of Xinjiang Production and Construction Corps,Wujiaqu,Xinjiang 831300,China)

机构地区：[1]新疆生产建设兵团第六师医院输血科,新疆五家渠831300

出　　处：《国际检验医学杂志》2023年第20期2521-2525,共5页International Journal of Laboratory Medicine

摘　　要：目的探讨乙型肝炎(乙肝)肝硬化上消化道出血(UGB)患者血清促血小板生成素(TPO)、人类软骨糖蛋白39(YKL-40)水平变化及对弥散性血管内凝血(DIC)发生风险的指导意义。方法选取该院2020年6月至2022年6月乙肝肝硬化患者195例,根据是否并发UGB分为UGB组(n=92)与非UGB组(n=103)。比较两组一般资料及血清TPO、YKL-40水平。采用Logistic回归分析乙肝肝硬化患者UGB发生的影响因素,乙肝肝硬化UGB患者DIC发生的影响因素,以及TPO、YKL-40参与UGB发生的交互作用,采用受试者工作特征(ROC)曲线分析血清TPO、YKL-40水平对乙肝肝硬化UGB患者DIC发生风险的预测价值。结果两组患者肝功能分级、血小板计数、腹水、TPO、YKL-40比较,差异有统计学意义(P<0.05);Logistic回归分析显示,血清TPO水平降低、YKL-40水平升高均为乙肝肝硬化患者UGB发生的独立危险因素(P<0.05),且TPO、YKL-40对乙肝肝硬化患者UGB发生存在负向交互作用;Logistic回归分析显示,血小板计数、TPO水平降低及YKL-40水平升高均为乙肝肝硬化UGB患者DIC发生的独立危险因素(P<0.05);ROC曲线分析显示,TPO、YKL-40预测DIC发生的曲线下面积(AUC)均较高,二者联合预测的AUC为0.838,大于单独预测(P<0.001)。结论乙肝肝硬化UGB患者血清TPO、YKL-40异常表达,且可有效预测DIC发生风险。Objective To explore the changes of serum thrombopoietin(TPO)and human cartilage glycoprotein 39(YKL-40)levels in upper gastrointestinal hemorrhage(UGB)patients with hepatitis B cirrhosis and their guiding significance on the risk of disseminated intravascular coagulation(DIC).Methods A total of 195 patients with hepatitis B cirrhosis in this hospital from June 2020 to June 2022 were selected and divided into UGB group(n=92)and non-UGB group(n=103)according to whether they were complicated with UGB.The general information and serum levels of TPO and YKL-40 were compared between the two groups.Logistic regression analysis was used to analyze the influencing factors of UGB and risk of DIC in patients with hepatitis B cirrhosis,and the interaction between TPO and YKL-40.The predictive value of serum TPO and YKL-40 in predicting the risk of DIC in patients with hepatitis B cirrhosis and UGB was analyzed by receiver operating characteristic(ROC)curve.Results There were significant differences in liver function grade,platelet count,ascites,TPO and YKL-40 between the two groups(P<0.05).Logistic regression analysis showed that decreased serum TPO level and increased YKL-40 level were independent risk factors for UGB in patients with hepatitis B cirrhosis(P<0.05),and there was a negative interaction between TPO and YKL-40 on UGB in patients with hepatitis B cirrhosis.Logistic regression analysis showed that decreased platelet count,TPO level and increased YKL-40 level were independent risk factors for DIC in patients with hepatitis B cirrhosis(P<0.05).ROC curve analysis showed that the area under the curve(AUC)predicted by TPO and YKL-40 for DIC was higher,and the AUC predicted by the combination of TPO and YKL-40 was 0.838,which was greater than predicted separately(P<0.001).Conclusion Serum TPO and YKL-40 are abnormally expressed in UGB patients with hepatitis B cirrhosis,and both could effectively predict the risk of DIC.

关 键 词：乙肝肝硬化 消化道出血 促血小板生成素 人类软骨糖蛋白39 弥漫性血管内凝血 

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