摘要
目的探究血栓弹力图(TEG)参数联合血清白细胞表面分化抗原40配体(CD40L)、6-酮前列腺素F1α(6-K-PGF1α)对乙型病毒性肝炎(简称乙肝)肝硬化上消化道出血(UGIB)患者伴发弥散性血管内凝血(DIC)的早期诊断价值。方法根据是否并发UGIB将172例乙肝肝硬化患者分为非UGIB组(96例)和UGIB组(76例);再根据是否发生DIC将UGIB组患者分为非DIC组(49例)和DIC组(27例)。收集所有患者的一般临床资料和实验室检查指标并进行分组比较。采用多因素logistic回归分析评估乙肝肝硬化患者发生UGIB及伴发DIC的影响因素;采用受试者工作特征(ROC)曲线评估TEG参数联合血清CD40L、6-K-PGF1α对乙肝肝硬化UGIB患者伴发DIC的诊断效能。结果UGIB组重度食管静脉曲张患者比例、弹力图最大振幅(MA)、血清CD40L及6-K-PGF1α水平均显著高于非UGIB组,PLT水平、凝血反应时间(R)及血凝块形成时间(K)显著低于非UGIB组;DIC组患者MA、血清CD40L及6-K-PGF1α水平均显著高于非DIC组(P<0.05)。多因素logistic回归分析结果显示,重度食管静脉曲张、MA及血清CD40L、6-K-PGF1α水平均是乙肝肝硬化患者发生UGIB的危险因素,PLT、R、K则是其保护因素;MA、血清CD40L及6-K-PGF1α均是影响乙肝肝硬化UGIB患者伴发DIC的危险因素(P<0.05)。ROC曲线分析结果显示,MA、血清CD40L及6-K-PGF1α二者联合诊断乙肝肝硬化UGIB患者伴发DIC的AUC显著高于3项单项诊断(P<0.05)。结论乙肝肝硬化UGIB患者TEG参数、血清CD40L、6-K-PGF1α水平均显著变化,三者联合检测用于诊断患者发生DIC的价值较高。
Objective To explore the early diagnostic value of thrombelastography(TEG)parameters combined with serum cluster of differentiation 40 ligand(CD40L)and 6⁃ketoprostaglandin F1 alpha(6⁃K⁃PGF1α)for disseminated intravascular coagulation(DIC)in patients with hepatitis B cirrhosis upper gastrointestinal bleeding(UGIB).Methods 172 patients with hepatitis B cirrhosis were divided into non⁃UGIB group(96 cases)and UGIB group(76 cases)based on the presence or absence of concurrent UGIB.UGIB group patients were further stratified into non⁃DIC group(49 cases)and DIC group(27 cases)according to the occurrence of DIC.General clinical data and laboratory test indicators were collected from all patients and compared across groups.Multivariate logistic regression analysis was used to identify influencing factors for UGIB and concomitant DIC in patients with hepatitis B cirrhosis.Receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic efficacy of TEG parameters combined with serum CD40L and 6⁃K⁃PGF1αfor DIC in hepatitis B cirrhosis patients with UGIB.Results The UGIB group had a significantly higher proportion of patients with severe esophageal varices,along with significantly elevated maximum amplitude(MA),serum CD40L and 6⁃K⁃PGF1αlevels,but significantly lower PLT count clotting reaction time(R)and clot formation time(K)levels compared to non⁃UGIB group;In DIC group,MA,serum CD40L and 6⁃K⁃PGF1αlevels were significantly higher than those in non⁃DIC group(P<0.05).Multivariate logistic regression analysis showed that severe esophageal varices,MA,serum CD40L and 6⁃K⁃PGF1αwere risk factors for UGIB in patients with hepatitis B cirrhosis,while PLT,R and K were protective factors;Furthermore,MA,serum CD40L and 6⁃K⁃PGF1αwere identified as risk factors for the development of DIC in hepatitis B cirrhosis patients with UGIB(P<0.05).ROC curve analysis result showed that the combined diagnostic value of MA,serum CD40L and 6⁃K⁃PGF1αfor detecting DIC in patients with UGIB due to hepatitis B⁃related cirrhosis demonstrated a significantly higher AUC compared to any of the three individual diagnostic markers(P<0.05).Conclusion TEG parameters,serum CD40L and 6⁃K⁃PGF1αall showed prominent changes in UGIB patients with hepatitis B cirrhosis.The combined detection has high value in diagnosing DIC in patients.
作者
乔璎
朱长太
苏斌
翁巍
Qiao Ying;Zhu Changtai;Su Bin;Weng Wei(Department of Blood Transfusion,Tongren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200336,China;不详)
出处
《临床内科杂志》
2025年第10期819-823,共5页
Journal of Clinical Internal Medicine
基金
上海市崇明区“可持续发展科技创新行动计划”项目(CKY2021-20)。
