Clinical significance of the change in plasma D-dimer in patients with hepatitis B cirrhosis
-
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...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.
-
Key words:
- hepatitis B /
- liver cirrhosis /
- D-dimer /
- early diagnosis
-
[1] MOKDAD AA,LOPEZ AD,SHAHRAZ S,et al. Liver cirrhosis mortality in 187 countries between 1980 and 2010:A systematic analysis[J]. BMC Med,2014,12:145. [2] TAPPER EB,PARIKH ND. Mortality due to cirrhosis and liver cancer in the United States,1999-2016:Observational study[J]. BMJ,2018,362:k2817. [3] WANGJIA ML,LI SB. Hepatology[M]. Beijing:People's Medical Publishing House,2013:630-631.(in Chinese)王家马龙,李绍白.肝脏病学[M].北京:人民卫生出版社,2013:630-631. [4] BAKI JA,TAPPER EB. Contemporary epidemiology of cirrhosis[J]. Curr Treat Options Gastroenterol,2019,17(2):244-253. [5] PALARETI G COSMI B,LEGNANI C,et al. D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism:A management study[J]. Blood,2014,124(2):196-203. [6] Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J]. J Clin Hepatol,2015,31(12):1941-1960.(in Chinese)中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960. [7] LYU J,DONG SS,GU HT,et al. TCM syndrome characteristics of portal vein thrombosis in patients with liver cirrhosis and related risk factors[J]. J Clin Hepatol,2019,35(10):2210-2213.(in Chinese)吕靖,董思思,顾宏图,等.肝硬化并发门静脉血栓的危险因素及中医证候特点[J].临床肝胆病杂志,2019,35(10):2210-2213.' [8] QIAN HC,LU ZQ,ZHANG TP. Clinical significance of procalcitonin combined with D-dimer in assessment of the severity of acute cholangitis[J]. J Clin Exp Med,2019,18(18):1949-1952.(in Chinese)钱海超,芦照青,张天鹏.血浆降钙素原与D-二聚体水平在判断急性胆管炎病情严重程度中的临床价值[J].临床和实验医学杂志,2019,18(18):1949-1952. [9] SUN HS,ZHU H,GAO HY,et al. Value of combined detection of tumor markers SCC-Ag,CEA,CYFRA21-1 and Ddimer in early diagnosis of non-small cell lung cancer[J]. J Jilin Univ(Med Edit),2018,44(5):1020-1024.(in Chinese)孙洪帅,朱华,高海燕,等.肿瘤标志物SCC-Ag、CEA、CYFRA21-1和D-二聚体联合检测对非小细胞肺癌的早期诊断价值[J].吉林大学学报(医学版),2018,44(5):1020-1024. [10] LE GAL G,RIGHINI M,WELLS PS. D-dimer for pulmonary embolism[J]. JAMA,2015,313(16):1668-1669. [11] DROLZ A,HORVATITS T,ROEDL K,et al. Coagulation parameters and major bleeding in critically ill patients with cirrhosis[J]. Hepatology,2016,64(2):556-568. [12] RAUTOU PE,VION AC,LUYENDYK JP,et al. Circulating microparticle tissue factor activity is increased in patients with cirrhosis[J]. Hepatology,2014,60(5):1793-1795. [13] LI Y,QI X,LI H,et al. D-dimer level for predicting the inhospital mortality in liver cirrhosis:A retrospective study[J].Exp Ther Med,2017,13(1):285-289. [14] PUGH RN,MURRAY-LYON IM,DAWSON JL,et al. Transection of the oesophagus for bleeding oesophageal varices[J]. Br J Surg,1973,60(8):646-649. [15] KAMATH PS,WIESNER RH,MALINCHOC M,et al. A model to predict survival in patients with end-stage liver disease[J]. Hepatology,2001,33(2):464-470. [16] QI T,ZHU C,LU G,et al. Elevated D-dimer is associated with increased 28-day mortality in acute-on-chronic liver failure in China:A retrospective study[J]. BMC Gastroenterol,2019,19(1):20. [17] WANNHOFF A,MLLER OJ,FRIEDRICH K,et al. Effects of increased von Willebrand factor levels on primary hemostasis in thrombocytopenic patients with liver cirrhosis[J]. PLo S One,2014,9(11):e112583. [18] SMALBERG JH,KOEHLER E,DARWISH MURAD S,et al. Fibrinogenγ'and variation in fibrinogen gamma genes in the etiology of portal vein thrombosis[J]. Thromb Haemost,2013,109(3):558-560. [19] SENZOLO M,SIMIONI P,ANDRIULLI A. Screening and treatment of portal vein thrombosis in cirrhosis[J]. Dig Liver Dis,2017,49(2):228-229. [20] XIONG JP,PENG YY,ZHANG YX. Screening for differentially expressed proteins in patients with liver cirrhosis complicated by portal vein thrombosis[J]. J Clin Hepatol,2018,34(1):112-117.(in Chinese)熊静平,彭媛媛,张跃新.肝硬化合并门静脉血栓患者的差异蛋白筛选[J].临床肝胆病杂志,2018,34(1):112-117. [21] CUI S,FU Z,FENG Y,et al. The disseminated intravascular coagulation score is a novel predictor for portal vein thrombosis in cirrhotic patients with hepatitis B[J]. Thromb Res,2018,161:7-11. [22] WEI Y,CHEN X,SHEN H,et al. P-selectin level at first and third day after portal hypertensive splenectomy for early prediction of portal vein thrombosis in patients with cirrhosis[J].Clin Appl Thromb Hemost,2018,24(9 Suppl):76s-83s. [23] MALAGUARNERA M,LATTERI S,BERTINO G,et al. D-dimer plasmatic levels as a marker for diagnosis and prognosis of hepatocellular carcinoma patients with portal vein thrombosis[J]. Clin Exp Gastroenterol,2018,11:373-380. [24] DAI J,QI X,LI H,et al. Role of D-dimer in the development of portal vein thrombosis in liver cirrhosis:A Meta-analysis[J]. Saudi J Gastroenterol,2015,21(3):165-174. [25] MALAGUARNERA G,VACANTE M,DRAGO F,et al. Endozepine-4 levels are increased in hepatic coma[J]. World J Gastroenterol,2015,21(30):9103-9110.
本文二维码
计量
- 文章访问数: 1450
- HTML全文浏览量: 98
- PDF下载量: 254
- 被引次数: 0