摘要
[目的]探讨失代偿期肝硬化患者门静脉血栓形成(PVT)的相关因素分析及D-二聚体/血小板比值(DPR)的预测价值.[方法]将103例失代偿期肝硬化患者作为本次研究对象,根据是否合并PVT分为血栓组(n=24)和非血栓组(n=79).收集临床相关资料,经单因素及多因素Logistic回归分析探讨失代偿期肝硬化患者PVT的影响因素.采用全自动凝血分析仪、全自动血液分析仪分别检测D-二聚体、血小板水平,并经受试者工作特性(ROC)曲线评估D-二聚体、血小板、DPR对失代偿期肝硬化患者PVT的预测价值.[结果]血栓组患者糖尿病史占比、脾脏切除史占比、门静脉主干直径大于非血栓组,白蛋白水平、凝血酶原时间、APTT小于非血栓组(P＜0.05).多因素Logistic回归分析显示,糖尿病史(OR=2.073,95％CI:1.454～2.956)、脾脏切除史(OR=3.114,95％CI:2.008～4.831)、门静脉主干直径增宽(OR=2.380,95％CI:1.621～3.494)、凝血酶原时间缩短(OR=0.370,95％CI:0.242～0.568)是失代偿期肝硬化患者PVT的影响因素(P＜0.05).血栓组D-二聚体水平及DPR高于非血栓组,血小板水平低于非血栓组(P＜0.05).D-二聚体、血小板水平及DPR预测失代偿期肝硬化患者PVT 的 AUC(95％CI)分别为 0.851(0.799～0.903)、0.762(0.710～0.814)、0.907(0.855～0.959),截断值分别为1.89 mg/L、41.59 × 109/L、4.33×10-11/mg,特异度分别为 66.87％、55.24％、87.15％,灵敏度分别为 91.67％、91.67％、84.96％.[结论]失代偿期肝硬化患者PVT与糖尿病史、脾脏切除史、门静脉主干直径增宽、凝血酶原时间缩短有关,应提高对此类高危患者的关注度,预防PVT.DPR可作为预测失代偿期肝硬化患者PVT的生物学标记物,可为临床诊疗提供新思路.
Abstract
[Objective]TTo explore the correlation factors of portal vein thrombosis(PVT)in decompen-sated cirrhosis and the predictive value of D-dimer/platelet ratio(DPR).[Methods]A total of 103 patients with decompensated cirrhosis were selected as the subjects of this study.They were divided into thrombe group(n=24)and non-thrombe group(n=79)according to whether or not they had PVTS.Clinical data were collected and univariate and multivariate Logistic regression analysis was performed to investigate the influencing factors of PVT in patients with decompensated cirrhosis.D-dimer and platelet levels were de-tected by automatic coagulation analyzer and automatic hematology analyzer,and the predictive value of D-dimer,platelet and DPR on PVT in patients with decompensated cirrhosis was evaluated by receiver operat-ing characteristic(ROC)curve.[Results]The proportion of diabetes history,splenectomy history and portal vein main diameter in thrombus group were higher than those in non-thrombus group,and the level of albu-min,prothrombin time and APTT were lower than those in non-thrombus group(P＜0.05).Diabetes histo-ry(OR=2.073,95％CI:1.454-2.956),splenectomy history(OR=3.114,95％CI:2.008-4.831),wide-ning of portal vein main diameter(OR=2.380,95％CI:1.621-3.494)and shortened prothrombin time(OR=0.370,95％CI:0.242-0.568)were the influencing factors of PVT in decompensated cirrhosis(P＜0.05).The level of D-dimer and DPR in thrombus group was higher than that in non-thrombus group,and the level of platelet was lower than that in non-thrombus group(P＜0.05).The AUC(95％CI)of D-dimer,platelet level and DPR for predicting PVT in decompensated cirrhosis were 0.851(0.799-0.903),0.762(0.710-0.814)and 0.907(0.855-0.959),respectively.Truncation values were 1.89 mg/L,41.59 × 109/L,4.33 × 10-11/mg,specificity 66.87％,55.24％,87.15％,sensitivity 91.67％,91.67％,84.96％,respec-tively.[Conclusion]In patients with decompensated cirrhosis,PVTS are associated with diabetes history,splenectomy history,widening of portal vein main diameter,and shortening of prothrombin time.Attention should be paid to these high-risk patients to prevent PVTS.DPR can be used as a biological marker to pre-dict PVT in patients with decompensated cirrhosis,which can provide new ideas for clinical diagnosis and treatment.
NETL
NSTL
万方数据