外周血PT PTA PLT水平对慢性乙肝患者进展原发性肝癌预测价值分析  

Analysis of the Predictive Value of Peripheral Blood PT PTA and PLT Levels for Progression of Primary Liver Cancer in Patients with Chronic Hepatitis B

作　　者：牛兴杰[1] 刘志慧 王艳飞[1] 刘耀敏[1] 张国民[1] NIU Xingjie;LIU Zhihui;WANG Yanfei(The Affiliated Hospital of Chengde Medical University,Hebei Chengde 067000,China)

机构地区：[1]承德医学院附属医院感染性疾病科,河北承德067000

出　　处：《河北医学》2023年第10期1668-1672,共5页Hebei Medicine

基　　金：河北省承德市科技支撑计划,(编号:201804A028)。

摘　　要：目的:通过检测患者外周血血小板细胞计数(PLT)、凝血酶原时间(PT)、凝血酶原活跃度(PTA),分析其在乙肝后原发性肝癌预测价值。方法:选择2017年01月至2019年12月期间在医院就诊的慢性乙型肝炎患者161例,根据是否出现凝血异常,分为凝血功能异常组(n=76)和正常组(n=85),同时记录患者人口学资料、临床资料,连续观察3年,对观察结果进行对照分析,发现原发性肝癌患者46例,未发生肝癌115例,对发生肝癌患者进行单因素和多因素分析,并采用并受试者工作特征(ROC)曲线评价PLT、PT、PTA对原发性肝癌的预测价值。结果:两组患者的ALT、AST、AFP水平比较,凝血功能异常组显著升高,差异均有统计学意义(P<0.05);与未发生肝癌组比较,原发性肝癌组患者PLT、PTA、PT显著增加,差异有统计学意义(P<0.05)。将单因素分析中具有统计学意义的变量作为自变量,以是否发生原发性肝癌作为因变量进行多因素Logistic回归分析,结果显示,PLT(OR=3.525)、PTA(OR=215)和PT(OR=2.312)是患者发生原发性肝癌的影响因素(P<0.05)。PLT、PT、PTA的ROC曲线下面积分别为0.790、0.744和0.682,对乙肝患者发展为肝细胞癌的预测有统计学意义(P<0.001)。结论:PLT、PTA、PT在乙肝病毒相关肝细胞癌的疾病进展过程中具有较好的预测价值,其中PTA、PT能力优于PLT。Objective:To analyze the predictive value of platelet count(PLT),prothrombin time(PT)and prothrombin activity(PTA)in hepatocellular carcinoma after hepatitis B.Methods:A total of 161 patients with chronic hepatitis B who were hospitalized from January 2017 to December 2019 were selected.They were divided into two groups according to whether there was abnormal coagulation(n=76)and normal coagulation(n=85).At the same time,the demography data and clinical data of patients were recorded.The observation results were observed for three consecutive years.A comparative analysis was carried out to find 46 patients with primary liver cancer.Single factor and multi factor analysis were carried out for patients with liver cancer.The predictive value of PLT,PT,and PTA for primary liver cancer was evaluated using the receiver operating characteristic(ROC)curve.Results:The differences in ALT,AST,and AFP levels between the two groups were statistically significant(P<0.05).The levels of PLT,PTA and PT in chronic hepatitis B group and primary liver cancer group were significantly different(P<0.05).Using statistically significant var-iables in univariate analysis as independent variables and the occurrence of primary liver cancer as dependent variables for multivariate logistic regression analysis,the results showed that PLT(OR=3.525),PTA(OR=215),and PT(OR=2.312)were the influencing factors for the occurrence of primary liver cancer in patients(P<0.05).The area under the receiver operating characteristic of PLT,PT and PTA was 0.790,0.744 and 0.682,respectively,which had statistical significance in predicting the development of hepatocellular carcino-ma in patients with hepatitis B(P<0.001).Conclusion:PLT,PTA,and PT have a good predictive value in the progression of hepatitis B virus related hepatocellular carcinoma,and the ability of PTA and PT is better than PLT.

关 键 词：肝癌 凝血酶原时间 血小板计数 凝血酶原活动度 慢性乙型病毒性肝炎 

分 类 号：R512.62[医药卫生—内科学] R735.7[医药卫生—临床医学]