血漿D—二聚體水平與肝硬化患者病因、肝功能分級、并發癥的關聯分析

李志林　黃漢光　鄧恩平

【摘要】 目的：分析血漿D-二聚體水平在肝硬化患者不同病因、不同肝功能分級、不同并發癥之間的表達情況，探討其參考價值。方法：選擇2015年3月-2017年3月本院住院治療的肝硬化患者120例作為觀察組，另選擇同時期門診體檢的健康人群100例作為對照組，觀察兩組血清D-二聚體指標表達情況。結果：各病因組的D-二聚體水平與對照組比較，差異均有統計學意義（P<0.05）；不同病因組兩兩比較，病毒性肝炎組與酒精性肝硬化組、自身免疫性肝硬化組、原發性膽汁性肝硬化組、淤血性肝硬化組的D-二聚體水平比較，差異均有統計學意義（P<0.05）；酒精性肝硬化組與自身免疫性肝硬化組、淤血性肝硬化組比較，差異均有統計學意義（P<0.05）；其余各組比較，差異均無統計學意義（P>0.05）。各肝功能分組的D-二聚體水平與對照組比較，差異均有統計學意義（P<0.05）；其中A級組與B級組、C級組的D-二聚體水平比較，差異均有統計學意義（P<0.05）；B級組與C級組比較，差異有統計學意義（P<0.05）。合并腹水肝硬化組、不合并腹水肝硬化組的D-二聚體水平與對照組比較，差異均有統計學意義（P<0.05）；合并腹水肝硬化組與不合并腹水肝硬化組的D-二聚體水平比較，差異有統計學意義（P<0.05）。結論：肝硬化患者的D-二聚體水平明顯較正常人升高，且病因不同，D-二聚體升高水平不同，其中以病毒性和酒精性肝硬化最為明顯，考慮兩種病因對肝損害較大，影響到纖溶系統；另外肝功能分級越高，肝功能損傷越大，D-二聚體水平顯著升高，考慮D-二聚體可以作為肝硬化治療預后轉歸的參考指標；合并腹水的肝硬化患者的D-二聚體明顯升高，對于預測肝硬化進展合并腹水有參考價值。

【關鍵詞】 D-二聚體； 肝硬化； 病因； 肝功能分級； 腹水

Connection between Plasma D-Dimer Level and Etiology，Liver Function Classification and Complications in Patients with Cirrhosis/LI Zhi-lin，HUANG Han-guang，DENG En-ping.//Medical Innovation of China，2017，14（30）：112-115

【Abstract】 Objective：To analyze the correlation between plasma D-Dimer and etiology，liver function classification and complications in patients with cirrhosis.Method：120 patients with cirrhosis in our hospital from March 2015 to March 2017 were selected as observation group，and 100 healthy people were selected as control group at the same time，the expression of serum D-Dimer index of two groups were observed.Result：The D-Dimer level of each etiology group were compared with control group，the differences were statistically significant（P<0.05），the D-Dimer level of viral hepatitis group was compared with alcoholic cirrhosis group，autoimmune liver cirrhosis group，primary biliary cirrhosis group and stasis cirrhosis group，the differences were statistically significant（P<0.05），the D-Dimer level of alcoholic cirrhosis group were compared with autoimmune cirrhosis group and stasis cirrhosis group，the differences were statistically significant（P<0.05），and the other groups were compared，the differences were not statistically significant（P>0.05）.The D-Dimer levels of each liver function group were compared with control group，the differences were statistically significant（P<0.05），the D-Dimer level of A grade group were compared with B grade group and C grade group，the differences were statistically significant（P<0.05）；the D-Dimer level of B grade group and C grade group were compared，the difference was statistically significant（P<0.05）.The D-Dimer level of combined with ascites cirrhosis group and without ascites cirrhosis group were compared with control group，the differences were statistically significant（P<0.05），the D-Dimer level of combined with ascites cirrhosis group and without ascites cirrhosis group were compared，the difference was statistically significant（P<0.05）.Conclusion：D-Dimer levels in patients with liver cirrhosis are significantly higher than those of normal subjects，and the etiology is different，the levels increase of D-Dimer is different，among viral and alcoholic cirrhosis is the most obvious，consider two causes great damage to the liver，affect the fibrinolytic system，in addition，the higher grade of liver function classification，the greater the liver function injury，D-Dimer can also be positively increased，considering D-Dimer can be used as a reference index for prognosis of cirrhosis，the D-Dimer levels in cirrhosis patients with ascites are significantly increase，for the prediction of progression to cirrhosis with ascites have reference value.endprint

【Key words】 D-Dimer； Cirrhosis； Etiology； Liver function classification； Ascites

First-authors address：The Traditional Chinese Medical Hospital in Dianbai District of Maoming City，Maoming 525400，China

doi：10.3969/j.issn.1674-4985.2017.30.033

肝硬化是各種肝病終末期出現的病理改變[1]。我國是乙肝大國，因此我國的肝硬化患者絕大多數是由乙肝發展而來，另外臨床常見的還有酒精性肝硬化及自身免疫性肝硬化等[2]。肝硬化患者肝細胞呈彌漫性損害，慢性進行性進展[3]。因此臨床上對于肝硬化的發展、形成的診斷評估很欠缺，確診的金標準是行肝細胞穿刺，早期篩查診斷水平較低[4]。另外目前臨床上對于肝硬化的治療價值評估也缺乏有效的參考指標[5]，因此尋找對于肝硬化疾病進展預后具有參考價值的指標是許多醫師多年來研究的重點[6-7]。近些年來，許多醫師發現D-二聚體在評估肝臟疾病方面有一定的參考價值[8]，因為肝臟具有造血和凝血作用，許多凝血因子的生成和釋放均需要肝臟的參與[9]，而D-二聚體是纖維蛋白經纖溶酶水解所產生的一種特異性降解產物，是纖溶系統特異性的標志物。……