Primignani M, Dell'Era A, Bucciarelli P, Bottasso B, Bajetta M T, de Franchis R, Cattaneo M
Gastroenterology 3 Unit, IRCCS Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena Foundation, Milan, Italy.
Dig Liver Dis. 2008 Nov;40(11):874-81. doi: 10.1016/j.dld.2008.01.010. Epub 2008 Mar 10.
Variceal bleeding carries a high-mortality rate in patients with liver cirrhosis. Since coagulation and fibrinolysis are abnormal in these patients we evaluated whether or not abnormalities of these haemostasis systems were independently related to mortality.
Global coagulation, coagulation activation and fibrinolysis measurements were performed in 43 cirrhotics bleeding from esophageal varices at baseline and during follow-up and in 43 non-bleeding cirrhotic patients at baseline only.
Baseline measurements of coagulation activation and fibrinolysis were more impaired in bleeders. In bleeders, prothrombin time, tissue type plasminogen activator antigen and D-dimer plasma levels were persistently more abnormal in patients who died. High-D-dimer, infection, Child-Pugh C class and MELD score >or=17 were the significant predictors of death at univariate analysis. Two different multivariate analyses to assess the independent prognostic value of these variables, one including the Child-Pugh class, the other including MELD, were performed. Independent predictors of death were high-D-dimer and infection, but not Child-Pugh class, in the former; MELD and infection, but not D-dimer, in the latter.
Beside infection, high-D-dimer is a stronger predictor of death as compared to Child-Pugh C class, but not to a MELD score >or=17.
肝硬化患者的静脉曲张出血死亡率很高。由于这些患者存在凝血和纤溶异常，我们评估了这些止血系统的异常是否与死亡率独立相关。
对43例食管静脉曲张出血的肝硬化患者在基线期和随访期间进行了全面凝血、凝血激活和纤溶指标检测，并对43例非出血性肝硬化患者仅在基线期进行了检测。
出血患者的凝血激活和纤溶的基线检测结果受损更严重。在出血患者中，死亡患者的凝血酶原时间、组织型纤溶酶原激活物抗原和D - 二聚体血浆水平持续异常更明显。单因素分析显示，高D - 二聚体、感染、Child - Pugh C级和终末期肝病模型（MELD）评分≥17是死亡的显著预测因素。进行了两种不同的多因素分析以评估这些变量的独立预后价值，一种分析纳入了Child - Pugh分级，另一种分析纳入了MELD。在前一种分析中，死亡的独立预测因素是高D - 二聚体和感染，而非Child - Pugh分级；在后一种分析中，死亡的独立预测因素是MELD和感染，而非D - 二聚体。
除感染外，与Child - Pugh C级相比，高D - 二聚体是更强的死亡预测因素，但与MELD评分≥17相比则不然。
