血浆FIB、D-D水平联合血栓弹力图参数检测对肝硬化合并上消化道出血的评估价值  

The Evaluation Value of Plasma FIB,D-D Levels Combined with Thromboelastography Parameters in Patients with Cirrhosis Complicated with Upper Gastrointestinal Bleeding

作　　者：赵郑 孙逯晟 李哲 王华玲[1] Zhao Zheng;Sun Lusheng;Li Zhe;Wang Hualing(Nanyang Second People's Hospital,Henan Nanyang 473000,China;Nanyang People's Hospital,Henan Nanyang 473000,China)

机构地区：[1]南阳市第二人民医院,河南南阳473000 [2]南阳市人民医院,河南南阳473000

出　　处：《哈尔滨医药》2024年第5期15-18,共4页Harbin Medical Journal

摘　　要：目的探讨血浆纤维蛋白原(FIB)、D-二聚体(D-D)水平、血栓弹力图(TEG)参数联合检测对肝硬化合并上消化道出血(UGIB)的评估价值。方法选取103例肝硬化患者为研究对象,依据其是否并发UGIB分为出血组38例、未出血组65例,依据出血严重程度将出血组分为轻度14例、中度14例、重度10例,比较两组与不同出血严重程度者血浆FIB、D-D水平、TEG参数[凝血反应时间(R)、凝血形成时间(K)、血栓最大振幅(MA)]。单因素、多因素Logistic回归分析肝硬化患者并发UGIB的影响因素。采用ROC分析血浆FIB、D-D水平、TEG参数对肝硬化患者并发UGIB的评估价值。结果出血组血浆FIB水平及MA低于未出血组,D-D水平及R、K高于未出血组(P<0.05);随着出血严重程度加重,血浆FIB水平及MA呈下降趋势,血浆D-D水平及R、K呈上升趋势(P<0.05);D-D、R、K、FIB、MA为UGIB发生的影响因素(P<0.05);血浆FIB、D-D水平、TEG参数联合诊断UGIB发生的AUC大于单项指标诊断(P<0.05)。结论肝硬化合并UGIB患者血浆FIB水平、MA降低,血浆D-D水平、R、K升高,联合检测其水平对肝硬化患者并发UGIB具有一定评估价值。Objective To investigate the value of combined detection of plasma fibrinogen(FIB),D-dimer(D-D)levels,and thromboelastography(TEG)parameters in evaluating cirrhosis complicated with upper gastrointestinal bleeding(UGIB).Methods A total of 103 patients with cirrhosis were selected as research objects.According to whether they were complicated by UGIB,they were divided into a bleeding group(38 cases)and a non-bleeding group(65 cases).According to the severity of bleeding,the bleeding group was divided into a mild group(14 cases),a moderate group(14 cases)and a severe group(10 cases).Plasma FIB,D-D levels,TEG parameters[coagulation response time(R),coagulation formation time(K),maximum amplitude of thrombus(MA)]were compared between the two groups and those with different bleeding severity.Univariate and multivariate Logistic regression were used to analyze the influencing factors of UGIB in patients with cirrhosis.The evaluation value of plasma FIB,D-D levels,and TEG parameters for cirrhotic patients with UGIB was assessed using ROC analysis.Results The level of plasma FIB and MA in the bleeding group were lower than those in the non-bleeding group,and the level of D-D,R and K were higher than those in the non-bleeding group(P<0.05).With the aggravation of bleeding severity,plasma FIB level and MA showed a decreasing trend,while plasma D-D level,R and K showed an increasing trend(P<0.05).D-D,R,K,FIB,and MA were influential factors in the occurrence of UGIB(P<0.05);the AUC for the combined diagnosis of the occurrence of UGIB by plasma FIB,D-D levels,and TEG parameters was greater than that for the diagnosis by a single index(P<0.05).Conclusion In patients with cirrhosis complicated with UGIB,plasma FIB level and MA level are decreased,plasma D-D level,R,K level are increased,and the combined detection of their levels has certain evaluate value in patients with cirrhosis complicated with UGIB.

关 键 词：肝硬化 上消化道出血 纤维蛋白原 D-二聚体 血栓弹力图 

分 类 号：R573.2[医药卫生—消化系统]