乙型肝炎肝硬化患者血浆D-二聚体水平变化的临床意义

徐静; 纪冬; 王春艳; 付懿铭; 陈松海; 李忠斌; 陈国凤

doi:10.3969/j.issn.1001-5256.2020.03.016

乙型肝炎肝硬化患者血浆D-二聚体水平变化的临床意义

DOI: 10.3969/j.issn.1001-5256.2020.03.016

1. 安徽省阜阳市第二人民医院肝脏病科二病区
2. 解放军总医院第五医学中心肝硬化诊疗二中心

基金项目:

首都临床特色应用研究特色课题(Z181100001718034)；菊梅肝胆病防治能力建设专项基金重点项目(2018JM12603003)；中国肝炎防治基金会王宝恩肝纤维化研究基金重点项目(2011xjs0408)；

详细信息

中图分类号: R512.62;R575.2
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出版历程
- 收稿日期: 2019-10-10
- 出版日期: 2020-03-20

Clinical significance of the change in plasma D-dimer in patients with hepatitis B cirrhosis

Second Ward of Department of Liver Diseases,Fuyang Second People's Hospital

Research funding:

摘要

摘要: 目的评估血浆D-二聚体水平与乙型肝炎肝硬化患者病情严重程度的相关性及诊断门静脉血栓形成（PVT）的价值。方法收集2018年1月-12月就诊于解放军第五医学中心的500例乙型肝炎肝硬化患者的临床资料,根据血浆D-二聚体水平是否正常分为正常组（n=217）和升高组（n=283）,比较两组患者血浆D-二聚体水平与Child-Pugh分级、MELD评分的相关性。正态分布的计量资料两组间比较采用t检验。非正态分布的计量资料两组间比较采用Mann-Whitney U检验;多组间比较及进一步两两比较均采用Kruskal-Wallis H检验。计数资料两组间比较采用χ2检验。相关性分析采用Spearman相关分析。利用受试者工作特征曲线（ROC曲线）分析评价D-二聚体水平对乙型肝炎肝硬化患者PVT的早期预警效能。结果两组患者D-二聚体水平、ALT、AST、TBil、Alb、Child-Pugh分级、MELD评分、PVT发生率比较,差异均有统计学意义（P值均<0. 05）。相关性分析结果显示,两组患者血浆D-二聚体水平与Child-Pugh分级、MELD评分均呈正相关（r值分...
- 肝炎,乙型 /
- 肝硬化 /
- D-二聚体 /
- 早期诊断
Abstract: Objective To investigate the correlation between plasma D-dimer level and severity of hepatitis B cirrhosis and its value in the diagnosis of portal vein thrombosis( PVT). Methods A retrospective analysis was performed for the clinical data of 500 patients with hepatitis B cirrhosis who were hospitalized in The Fifth Medical Center of Chinese PLA General Hospital from January to December,2018,and according to the plasma level of D-dimer,they were divided into normal group with 217 patients and elevated group with 283 patients. The correlations of plasma D-dimer level with Child-Pugh class and Model for End-Stage Liver Disease( MELD) score were compared between the two groups. The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the Kruskal-Wallis H test was used for multiple groups comparison and further pairwise comparison. The chi-square test was used for comparison of categorical data between two groups. A Spearman correlation analysis was used to investigate correlation. The receiver operating characteristic( ROC) curve was used to evaluate the early warning performance of D-dimer level for PVT in patients with hepatitis B cirrhosis. Results There were significant differences between the two groups in D-dimer level,alanine aminotransferase,aspartate aminotransferase,total bilirubin,albumin,Child-Pugh class,MELD score,and incidence rate of PVT( all P < 0. 05). The correlation analysis showed that plasma D-dimer level was positively correlated with Child-Pugh class and MELD score in both groups( r = 0. 463,0. 455,0. 214,and 0. 756,all P <0. 05). A total of 50 patients with hepatitis B cirrhosis were found to have PVT; the patients with PVT had a significantly higher D-dimer level that those without PVT [1. 96( 0. 82-4. 91) mg/L vs 0. 61( 0. 19-1. 54) mg/L,Z =-6. 02,P < 0. 001]. The ROC curve analysis showed that D-dimer level had an area under the ROC curve of 0. 758( 95% confidence interval: 0. 719-0. 796) at the optimal cut-off value of 0. 76 mg/L. Conclusion Plasma D-dimer level is correlated with the severity of hepatitis B cirrhosis and can be used to predict the prognosis of patients with hepatitis B cirrhosis. The possibility of PVT should be considered in patients with an elevated D-dimer level.
- hepatitis B /
- liver cirrhosis /
- D-dimer /
- early diagnosis

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参考文献(25)

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