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目的探讨D-二聚体水平和肝硬化患者病因、肝功能分级、并发症等的相关性,为肝硬化患者病情诊断、预后判定提供依据。方法回顾性分析2011年1月至2016年12月在阳江市南恩街道社区卫生服务中心接受治疗的310例肝硬化患者临床资料,根据肝硬化患者病因、肝功能分级及并发症将患者进行分组,另择同期体检的健康者作60例为对照组,比较各组间血浆D-二聚体水平差异。结果不同病因分组的D-二聚体水平:病毒性肝炎组(2.38±0.26)mg/L、血吸虫肝硬化组(2.63±0.71)mg/L、自身免疫性肝硬化组(1.91±0.36)mg/L、酒精性肝硬化组(3.43±0.62)mg/L、隐源性肝硬化组(3.53±0.63)mg/L,分别与对照组(0.22±0.14)mg/L比较,差异均有统计学意义(t=61.23、24.95、29.63、38.39、39.84,P<0.05);但在不同病因组间差异无统计学意义(P>0.05)。不同肝功能分级按D-二聚体水平由低到高:对照组(0.22±0.14)mg/L,肝功能A级组(1.19±0.20)mg/L,肝功能B级组(2.22±0.23)mg/L,肝功能C级组(4.44±0.47)mg/L,肝功能分级各组间比较,差异有统计学意义(r=0.152,P<0.05)。不同并发症组间按D-二聚体水平由低到高:对照组(0.22±0.14)mg/L,无腹水组(1.63±0.25)mg/L,腹水组(2.19±0.15)mg/L,腹水组高于无腹水组和对照组,差异有统计学意义(t=24.60、90.56,P<0.05),无腹水组D-二聚体水平显著高于对照组,差异有统计学意义(t=40.33,P<0.05)。结论肝硬化患者D-二聚体水平在病因诊断方面缺乏特殊诊断意义,但可作为患者肝功能情况的判定指标,腹水可能是引发患者发生纤溶亢进的机制之一。
Objective To investigate the relationship between D-dimer level and etiology, classification of liver function and complications in cirrhotic patients, and to provide basis for the diagnosis and prognosis of patients with cirrhosis. Methods A retrospective analysis of clinical data of 310 patients with cirrhosis who were treated at Community Health Service Center, Nan’en Street, Yangjiang City from January 2011 to December 2016 was performed. Patients were divided into groups according to the etiology, grade of hepatic function and complications , While the other 60 healthy subjects who chose to take physical examination at the same period as the control group. The differences of plasma D-dimer levels between the groups were compared. Results The levels of D-dimer in different etiology groups were 2.38 ± 0.26 mg / L in viral hepatitis group, 2.63 ± 0.71 mg / L in schistosomiasis cirrhosis group and 1.91 ± 0.36 mg / L in autoimmune cirrhosis group / L, alcoholic cirrhosis (3.43 ± 0.62) mg / L and cryptogenic cirrhosis (3.53 ± 0.63) mg / L, respectively, compared with the control group (0.22 ± 0.14) mg / L (T = 61.23,24.95,29.63,38.39,39.84, P <0.05). However, there was no significant difference among different etiologies (P> 0.05). The levels of D-dimer in different grades of liver function were from low to high: control group (0.22 ± 0.14) mg / L, liver function group A (1.19 ± 0.20) mg / L and liver function group B (mg / L) and grade C (4.44 ± 0.47) mg / L, respectively. There was a significant difference between the three groups (r = 0.152, P <0.05). According to the level of D-dimer, the levels of D-dimer in control group (0.22 ± 0.14) mg / L, ascites group (1.63 ± 0.25) mg / L and ascites group (2.19 ± 0.15) mg / L (T = 24.60,90.56, P <0.05). The level of D-dimer in ascites group was significantly higher than that in control group (P <0.05), the difference was statistically significant (t = t = 40.33, P <0.05). Conclusions The level of D-dimer in patients with cirrhosis is lack of special diagnostic significance in the diagnosis of etiology. However, it may be used as a marker for the evaluation of liver function in patients with cirrhosis. Ascites may be one of the mechanisms leading to fibrinolysis in patients.