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摘要：
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摘要：目的 探讨肝硬化消化道出血患者抗凝血酶Ⅲ（antithrombin-Ⅲ，AT-Ⅲ）和D二聚体（D-dimer，D-D）水平变化及临床意义。方法 选取2017年1月至2021年6月常
州市第三人民医院196例肝硬化消化道出血患者为观察组，另选取同期98例肝硬化未
伴消化道出血患者为对照组。检测两组患者血AT-Ⅲ、D-D水平，采用多因素Logistic
回归分析肝硬化消化道出血的影响因素，比较观察组不同出血程度患者血AT-Ⅲ、D-D
水平，采用Spearman法分析血AT-Ⅲ、D-D水平与出血程度的相关性。结果 观察组血
AT-Ⅲ水平显著低于对照组 [（31.28 ± 7.67）% vs（35.62 ± 8.34）%]，D-D水平显著高
于对照组 [（4.23 ± 0.96）mg/L vs（3.68 ± 0.87）mg/L]，差异均有统计学意义（t值分别
为4.441、4.775，P均＜ 0.001）。校正Child-Pugh分级、消化道溃疡、食管静脉曲张程
度、胃底静脉曲张程度后血AT-Ⅲ（OR = 0.411，95%CI：0.207～0.816，P = 0.021）和
D-D水平（OR = 3.768，95%CI：1.821～7.798，P ＜ 0.001）仍为肝硬化消化道出血的
影响因素。观察组患者随出血程度增加，AT-Ⅲ呈下降趋势，D-D呈升高趋势（P均＜
0.05）；观察组血AT-Ⅲ与出血程度呈负相关（rs = -0.573，P ＜ 0.001），D-D与出血程
度呈正相关（rs = 0.509，P ＜ 0.001）。结论 肝硬化消化道出血患者AT-Ⅲ、D-D异常表
达，其表达水平与患者出血程度密切相关，临床应密切监测肝硬化患者AT-Ⅲ、D-D变
化，以预防消化道出血风险。
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Abstract: Objective To investigate the changes and clinical significance of blood antithrombin
Ⅲ (AT-Ⅲ) and D-dimer (D-D) levels in liver cirrhosis patients with gastrointestinal bleeding.
Methods A total of 196 liver cirrhosis patients with gastrointestinal bleeding in Changzhou Third
People’s Hospital from January 2017 to June 2021 were selected as observation group, and 98
liver cirrhosis patients without gastrointestinal bleeding during the same period were selected as
control group. Blood AT-Ⅲ and D-D levels were detected in both groups. Multivariate Logistic
regression was used to analyze the factors affecting gastrointestinal bleeding in liver cirrhosis.
The blood AT-Ⅲ and D-D levels of patients with different bleeding degrees in observation
group were compared. The correlation between blood AT-Ⅲ, D-D levels and bleeding degree
was analyzed by Spearman method. Results The blood AT-Ⅲ level of patients in observation
group was lower than that of control group [(31.28 ± 7.67)% vs (35.62 ± 8.34)%], and the
D-D level was higher than that of control group [(4.23 ± 0.96) mg/L vs (3.68 ± 0.87) mg/L],
the differences were statistically significant (t = 4.441, P ＜ 0.001; t = 4.775, P ＜ 0.001).
After adjusting for Child-Pugh grade, peptic ulcer, esophageal varices, and gastric fundus
varices, blood AT-Ⅲ (OR = 0.411, 95%CI: 0.207～0.816, P = 0.021) and D-D levels (OR =
3.768, 95%CI: 1.821～7.798, P ＜ 0.001) were still the influencing factors of gastrointestinal
bleeding in liver cirrhosis. For patients in observation group, with the increase of bleeding
degree, AT-III showed a downward trend, and D-D showed an upward trend (both P ＜ 0.05).
In observation group, blood AT-Ⅲ was negatively correlated with the degree of bleeding
(rs = -0.573, P ＜ 0.001), and D-D was positively correlated with the degree of bleeding (rs =
0.509, P ＜ 0.001). Conclusions The abnormal expression of AT-Ⅲ and D-D in liver cirrhosis
patients with gastrointestinal bleeding are closely related to the expression level and the
degree of bleeding. The changes of AT-Ⅲ and D-D in patients with liver cirrhosis should be
closely monitored to prevent the risk of gastrointestinal bleeding.
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