Detection of five coagulation indices in patients with cirrhosis and its clinical significance
Received date: 2021-07-13
Online published: 2022-06-28
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。
赵英妹, 聂红明, 张珏, 黄燕 . 肝硬化患者凝血五项的测定及其临床意义[J]. 诊断学理论与实践, 2021 , 20(05) : 480 -483 . DOI: 10.16150/j.1671-2870.2021.05.012
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
[1] | 崔云, 张育才, 祝益民. 重视危重症儿童急性肝功能衰竭的诊断与治疗[J]. 中华急诊医学杂志, 2015,24(6):584-587. |
[2] | 付政文. 止凝血功能指标在乙肝、肝硬化及肝衰竭患者中的变化规律[J]. 血栓与止血学, 2017,23(4):609-611. |
[3] | 陈欣, 刘怀平, 刘树业. 肝癌肝硬化患者生化、凝血指标与Child-Pugh分级之间的相关性[J]. 中国老年学杂志, 2013,33(20):4974-4976. |
[4] | Baki JA, Tapper EB. Contemporary Epidemiology of Cirrhosis[J]. Curr Treat Options Gastroenterol, 2019,17(2):244-253. |
[5] | 徐静, 纪冬, 王春艳, 等. 乙型肝炎肝硬化患者血浆D-二聚体水平变化的临床意义[J]. 临床肝胆病杂志, 2020,36(3):551-555. |
[6] | 闫永. 血浆D-二聚体与凝血四项联合检测对肝硬化患者的临床价值[J]. 中国冶金工业医学杂志, 2019,36(1):112. |
[7] | 覃乃辉, 裴正玲, 周达利, 等. AT-Ⅲ活性与D-D含量变化在不同程度肝损伤中的应用[J]. 重庆医学, 2014,43(36):4955-4957. |
[8] | 中华医学会肝病学分会. 肝硬化诊治指南[J]. 现代医药卫生, 2020,36(2):320-337. |
[9] | 胡丽, 张雅丽, 谭红阳, 等. 肝炎后肝硬化病人症状群纵向研究进展[J]. 护理研究, 2019,33(6):992-997. |
[10] | Sinegre T, Duron C, Lecompte T, et al. Increased factor Ⅷ plays a significant role in plasma hypercoagulability phenotype of patients with cirrhosis[J]. J Thromb Haemost, 2018,16(6):1132-1140. |
[11] | 余天会. 探讨血浆D-二聚体检测对肝病诊断的意义[J]. 检验医学与临床, 2014,11(21):2987-2988. |
[12] | Raya-Sánchez JM, González-Reimers E, Rodríguez-Martín JM, et al. Coagulation inhibitors in alcoholic liver cirrhosis[J]. Alcohol, 1998,15(1):19-23. |
[13] | 邓永东, 彭雪彬, 姚立琼, 等. 乙型肝炎肝硬化患者促凝和抗凝血因子变化分析[J]. 临床肝胆病杂志, 2019, 35(2):345-348. |
/
〈 |
|
〉 |