诊断学理论与实践

诊断学理论与实践 ›› 2021, Vol. 20 ›› Issue (05): 480-483.doi: 10.16150/j.1671-2870.2021.05.012

• 论著 • 上一篇    下一篇

肝硬化患者凝血五项的测定及其临床意义

赵英妹a, 聂红明b, 张珏a, 黄燕a()   

  1. a.上海中医药大学附属曙光医院 检验科,上海 200135
    b.上海中医药大学附属曙光医院 肝病科,上海 200135
  • 收稿日期:2021-07-13 出版日期:2021-10-25 发布日期:2022-06-28
  • 通讯作者: 黄燕 E-mail:sangshen1977@163.com

Detection of five coagulation indices in patients with cirrhosis and its clinical significance

ZHAO Yingmeia, NIE Hongmingb, ZHANG Juea, HUANG Yana()   

  1. a. Department of Clinical Laboratory, Shuguang Hospital, Shanghai Traditional Chinese Medicine University, Shanghai 200135, China
    b. Division of Liver Disease, Shuguang Hospital, Shanghai Traditional Chinese Medicine University, Shanghai 200135, China
  • Received:2021-07-13 Online:2021-10-25 Published:2022-06-28
  • Contact: HUANG Yan E-mail:sangshen1977@163.com

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摘要：

目的：探讨血浆中凝血五项[纤维蛋白原（fibrinogen,FIB）、D-二聚体（D-dimer,DD）、抗凝血酶Ⅲ（antithrombin Ⅲ,AT-Ⅲ）、蛋白C（protein C,PC）活性、蛋白S（protein S,PS）活性]联合检测在不同程度肝硬化辅助诊断中的意义。 方法：收集2019年10月至2021年6月来我院治疗的418例肝硬化患者,其中处于肝硬化代偿期的患者有138例（代偿组）,处于肝硬化失代偿期的患者为280例（失代偿组）,同时选择同期体检的115名健康人作为正常对照组。对3组进行凝血五项检测,并分析比较3组之间的结果差异。 结果：肝硬化代偿组及失代偿组患者的抗凝血因子AT-Ⅲ、PC和PS活性均较正常对照组显著下降（P<0.01）,而肝硬化代偿组与失代偿组之间这3项指标也有显著差异（P<0.01）。肝硬化代偿组与正常对照组之间的DD、FIB差异无统计学意义（P值分别为0.061和0.270）,但肝硬化代偿组与失代偿组之间的DD、FIB有显著差异（P<0.01）。PC、PS及AT-Ⅲ区分肝硬化与正常人的受试者操作特征曲线（receiver operating characteristic curve,ROC曲线）的曲线下面积 （area under curve,AUC）分别为0.947、0.952、0.935,而三者区分肝硬化代偿期和肝硬化失代偿期的AUC分别为0.786、0.657、0.761。 结论：除了FIB、DD、AT-Ⅲ,PC活性、PS活性也与肝硬化的严重程度相关,肝硬化早期PC活性、PS活性已有明显变化。PC、PS及AT-Ⅲ联合检测可用于辅助诊断肝硬化。

关键词: 肝硬化, 纤维蛋白原, D-二聚体, 抗凝血酶Ⅲ, 蛋白C, 蛋白S

Abstract:

Objective: To investigate clinical significance of detections of fibrinogen (FIB), D-dimer (DD), antithrombin Ⅲ(AT-Ⅲ), protein C (PC) and protein S (PS) in plasma of patients with different degrees of cirrhosis. Methods: A total of 418 patients with cirrhosis treated in our hospital from October 2019 to June 2021 were enrolled as the observation group, including 138 patients with cirrhosis at the compensatory stage and 280 patients with cirrhosis at the decompensa-ted stage. Meanwhile, 115 healthy people who underwent physical examination during the same period were served as control group. The activities of FIB, DD, AT-Ⅲ, PC and PS were detected, and the differences in coagulation indictors between the cirrhosis compensatory group, the cirrhosis decompensated group and the normal control group were analyzed. Results: The activities of anticoagulant factors AT-Ⅲ, PC and PS in cirrhosis group were significantly decreased, than those with normal control group (P<0.01), and there were significant differences between compensatory group and decompensated group (P<0.01). There was no significant difference in DD and FIB between compensatory cirrhosis group and healthy control group (P=0.061 and P=0.270), but there was significant difference in DD and FIB between compensatory cirrhosis group and decompensated cirrhosis group (P<0.01). The area under curve (AUC) of receiver operating cha-racteristic (ROC curve) of AT-Ⅲ, PC, PS for distingiushing liver cirrhosis patients from health controls, liver decormpenation and liver compensation were 0.947, 0.952, and 0.935, and 0.786, 0.657 and 0.761. Conclusions: Besides FIB, DD and AT-Ⅲ, PC and PS activity are correlated with the severity of cirrhosis. In the early stage of cirrhosis, FIB and DD levels do not change significantly,but AT-Ⅲ, PC activity and PS activity change significantly. Therefore, dynamic combined detection of FIB, DD, AT-Ⅲ, PC activity and PS activity in patients with cirrhosis is helpful to monitoring development of the disease.

Key words: Cirrhosis of the liver, Fibrinogen, D-dimer, Antithrombin Ⅲ, Protein C, Protein S

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