肝硬化患者血小板参数、凝血指标与上消化道出血的相关性

摘要/Abstract

摘要： 目的探讨肝硬化患者血小板参数、凝血指标与上消化道出血的相关性。方法选择2020年1月至2021年1月聊城市人民医院收治的肝硬化合并上消化道出血患者45例(A组),肝硬化不合并上消化道出血患者的57例(B组),选择同期健康体检者49名(C组)。比较3组的血清血小板计数(PLT)、血小板平均体积(MPV)、血小板比容(PCT)、血小板分布宽度(PDW)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)的表达水平,采用Pearson相关分析血清PLT、MPV、PCT、PDW、APTT、PT、TT、FIB与上消化道出血的相关性。结果 A组PLT、MPV、PCT、PDW水平分别为(301.16±50.24)×10⁹/L、(8.37±1.34)fL、(0.25±0.06)%、(19.00±1.27)%,明显高于B组的(330.03±55.28)×10⁹/L、(9.38±1.50)fL、(0.35±0.10)%、(22.02±1.49)%和C组(200.15±40.30)×10⁹/L、(7.18±1.19)fL、(0.18±0.03)%、(16.36±1.02)%,且PLT、MPV、PCT、PDW水平均明显高于C组,差异有统计学意义(P<0.05)。A组、B组的TT水平分别为(17.35±0.72)s、(15.25±0.64)s,均明显低于C组的(19.78±1.03)s,A组、B组的APTT、PT、FIB水平分别为(33.15±5.30)s、(12.38±1.50)s、(4.52±0.74)s、(40.03±6.28)s、(14.37±2.34)s、(5.66±0.87)s,均明显高于C组(27.16±4.24)s、(11.18±1.09)s、(3.36±0.40)s,A组APTT、PT、FIB水平均明显低于B组,TT水平明显高于B组,差异有统计学意义(P<0.05)。Pearson相关分析显示,上消化道出血与TT呈负相关(r=-0.762,P<0.05),与PLT、MPV、PCT、PDW、APTT、PT、FIB水平呈正相关(r=0.618、0.391、0.400、0.537、0.451、0.328、0.694,P<0.05)。结论肝硬化患者血小板参数、凝血指标变化能为评估患者上消化道出血程度、出血倾向性,监测上述指标的水平变化对预测上消化道出血的临床意义重大。

关键词: 肝硬化, 血小板, 凝血功能, 上消化道出血, 相关性

Abstract: Objective To study on the changes of platelet parameters and coagulation indexes in patients with cirrhosis and their correlation with the incidence of upper gastrointestinal bleeding. Methods A retrospective analysis was performed on the medical records of 45 patients with cirrhosis complicated with upper gastrointestinal bleeding admitted from January 2020 to January 2021 (group A), 57 patients with cirrhosis without upper gastrointestinal bleeding (group B), and 49 normal people who received physical examination during the same period of time (group C). The levels of serum platelet count (PLT), mean platelet volume (MPV), platelet volume ratio (PCT), platelet distribution width (PDW), activated partial thrombin time (APTT), prothrombin time (PT), thrombin time (TT) and fibrinogen (FIB) in the three groups were compared, the correlation between serum PLT, MPV, PCT, PDW, APTT, PT, TT, FIB and upper gastrointestinal bleeding was analyzed by Pearson correlation analysis. Results The levels of PLT, MPV, PCT, and PDW were (301.16±50.24)×10⁹/L, (8.37±1.34) fL, (0.25±0.06)%, and (19.00±1.27)% in group A, which were significantly higher than those of (330.03±55.28)×10⁹/L, (9.38±1.50) fL, (0.35± 0.10)%, and (22.02±1.49)% in group B, and (200.15±40.30)×10⁹/L, (7.18±1.19)fL, (0.18±0.03)%, and (16.36±1.02)% in group C. The levels of PLT, MPV, PCT, PDW in group A were significantly higher than those in group C, the difference were statistically significant (P<0.05); the TT levels in groups A and B were (17.35±0.72)s and (15.25±0.64)s, respectively, which were significantly lower than that of (19.78±1.03)s in group C, The APTT, PT, and FIB levels were (33.15±5.30)s, (12.38±1.50)s, and (4.52±0.74)s in group A, (40.03±6.28)s, (14.37±2.34)s, and (5.66±0.87)s in group B, all were significantly higher than those of (27.16±4.24)s, (11.18±1.09)s, and (3.36±0.40)s in group C. The APTT, PT, and FIB levels in group A were significantly lower, whereas the TT level was significantly higher than those in group B, the differences were statistically significant (P<0.05); Pearson correlation analysis showed that the incidence of upper gastrointestinal hemorrhage was inversely correlated with TT (r=-0.762, P<0.05), whereas positively correlated with PLT, MPV, PCT, PDW, APTT, PT and FIB levels (r=0.618, 0.391, 0.400, 0.537, 0.451, 0.328, and 0.694, respectively, P<0.05). Conclusion The changes of platelet parameters and coagulation indexes in patients with cirrhosis can be used to evaluate the degree and tendency of upper gastrointestinal bleeding, and the monitoring of aboval indexes is of great clinical significance for predicting upper gastrointestinal bleeding.

Key words: Liver cirrhosis, Platelet, Blood coagulation function, Upper gastrointestinal bleeding, Correlation

苏小红, 李静博. 肝硬化患者血小板参数、凝血指标与上消化道出血的相关性[J]. 肝脏, 2023, 28(10): 1171-1174.

SU Xiao-hong, LI Jing-bo. The changes of platelet parameters and coagulation indexes in patients with cirrhosis and their correlation with upper gastrointestinal bleeding[J]. Chinese Hepatolgy, 2023, 28(10): 1171-1174.

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