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AΡΠΎΡΠΈΡΠ°ΡΠΈΡΠ° Π½Π° ΠΏΠ»Π°Π·ΠΌΠ° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΡΠΎ ΡΡΠ°Π΄ΠΈΡΠΌΠΈΡΠ΅ Π½Π° ΡΡΠ½ΠΎΠ΄ΡΠΎΠ±Π½Π° ΡΠΈΡΠΎΠ·Π° ΠΈ Π½Π΅ΡΠ·ΠΈΠ½ΠΈΡΠ΅ ΠΊΠΎΠΌΠΏΠ»ΠΈΠΊΠ°ΡΠΈΠΈ
Aim of the study: To investigate plasma D-dimer levels in correlation with Child-Pugh-Turcotte (CTP) and Model for End-Stage Liver Disease (MELD) scores in patients with liver cirrhosis (LC) of different severity, as well as the correlation with LC-associated clinical, biochemical parameters and complications. Material and methods: Fifty patients with LC were divided in three groups according to LC severity using the CTP Score (CTP-A, CTP-B, CTP-C).Β The levels of D-dimer were measured in sodium-citrate plasma on Siemens, BCS XP Blood Coagulometer. Kruskal-Wallis test was used to compare D-dimer levels between the groups. Mann-Whitney U test was used to evaluate the difference of D-dimer levels in groups with different MELD score, and to evaluate the difference in D-dimer levels in patients with presence or absence of ascites and the difference of D-dimer levels in patients with or without spontaneous bacterial peritonitis (SBP). Pearsonβs coefficient of correlation was used to evaluate the correlation between D-dimer levels with MELD score and the correlation between D-dimer levels and the concentration of LC-associated biochemical, clinical parameters and complications. Results: D-dimer levels increased with severity of the disease as assessed with CTP and MELD scores, with a statistically significant difference between the groups (p=.0000 and p=.0001, respectively). Group CTP-C demonstrated the highest D-dimer levels, followed by groups B and A. Patients with SBP had significantly higher levels of D-dimers than patients without SBP (p=.0006). A significant positive correlation between D-dimers and CTP and MELD score was detected (r= 0.74 and r=0.44, respectively; p<.001). A correlation between D-dimer levels and several biochemical parameters characterizing progressive liver dysfunction was observed. From all investigated biochemical parameters, the highest significant correlation was detected between D-dimer levels and the concentration of serum albumin (r= -0.65, p<.001). Conclusions: Plasma D-dimer levels are tightly correlated with the degree of liver dysfunction and LC-associated complications. Therefore, D-dimer levels could be utilized as a prognostic stratification marker and adjunctive diagnostic marker in LC-associated complications.Β Π¦Π΅Π» Π½Π° ΡΡΡΠ΄ΠΈΡΠ°ΡΠ°: ΠΠ° ΡΠ΅ ΠΈΡΠΏΠΈΡΠ° Π½ΠΈΠ²ΠΎΡΠΎ Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈ Π²ΠΎ ΠΏΠ»Π°Π·ΠΌΠ° Π²ΠΎ ΠΊΠΎΡΠ΅Π»Π°ΡΠΈΡΠ° ΡΠΎ ΠΊΠ»ΠΈΠ½ΠΈΡΠΊΠΈΡΠ΅ ΡΠΊΠΎΡΠΎΠ²ΠΈ: Child-Pugh-Turcotte (CTP) ΠΈ Model for End-Stage Liver Disease (MELD) ΠΊΠ°Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΡΠΎ ΡΡΠ½ΠΎΠ΄ΡΠΎΠ±Π½Π° ΡΠΈΡΠΎΠ·Π° ΡΠΎ ΡΠ°Π·Π»ΠΈΡΠ½Π° ΡΠ΅ΠΆΠΈΠ½Π°, ΠΊΠ°ΠΊΠΎ ΠΈ Π½ΠΈΠ²Π½Π° ΠΊΠΎΡΠ΅Π»Π°ΡΠΈΡΠ° ΡΠΎ ΠΊΠ»ΠΈΠ½ΠΈΡΠΊΠΈ, Π±ΠΈΠΎΡ
Π΅ΠΌΠΈΡΠΊΠΈ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΈ ΠΈ ΠΊΠΎΠΌΠΏΠ»ΠΈΠΊΠ°ΡΠΈΠΈ ΠΏΠΎΠ²ΡΠ·Π°Π½ΠΈ ΡΠΎ ΡΡΠ½ΠΎΠ΄ΡΠΎΠ±Π½Π° ΡΠΈΡΠΎΠ·Π°. ΠΠ°ΡΠ΅ΡΠΈΡΠ°Π»ΠΈ ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈ:Β ΠΠΊΡΠΏΠ½ΠΎ 50 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΡΠΎ ΡΠΈΡΠΎΠ·Π° Π½Π° ΡΡΠ½ Π΄ΡΠΎΠ± Π±Π΅Π° ΠΏΠΎΠ΄Π΅Π»Π΅Π½ΠΈ Π²ΠΎ ΡΡΠΈ Π³ΡΡΠΏΠΈ ΡΠΏΠΎΡΠ΅Π΄ ΡΠ΅ΠΆΠΈΠ½Π°ΡΠ° Π½Π° ΡΠΈΡΠΎΠ·Π° Π½Π° ΡΡΠ½ΠΈΠΎΡ Π΄ΡΠΎΠ± Π²ΡΠ· ΠΎΡΠ½ΠΎΠ²Π° Π½Π° CTP Score (CTP-A, CTP-Π, CTP-C). ΠΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ Π±Π΅ΡΠ΅ ΠΎΠ΄ΡΠ΅Π΄Π΅Π½Π° Π²ΠΎ ΠΏΠ»Π°Π·ΠΌΠ° ΡΠΎ Π½Π°ΡΡΠΈΡΠΌ ΡΠΈΡΡΠ°Ρ ΠΊΠΎΡΠΈΡΡΠ΅ΡΡΠΈ Π³ΠΎ Siemens, BCSXP ΠΊΡΠ²Π½ΠΈΠΎΡ ΠΊΠΎΠ°Π³ΡΠ»ΠΎΠΌΠ΅ΡΠ°Ρ. Kruskal-Wallis ΡΠ΅ΡΡΠΎΡ Π±Π΅ΡΠ΅ ΠΊΠΎΡΠΈΡΡΠ΅Π½ Π·Π° Π΄Π° ΡΠ΅ ΡΠΏΠΎΡΠ΅Π΄Π°Ρ Π½ΠΈΠ²ΠΎΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈ ΠΏΠΎΠΌΠ΅ΡΡ CTP Π³ΡΡΠΏΠΈΡΠ΅. Mann-Whitney U ΡΠ΅ΡΡΠΎΡ Π±Π΅ΡΠ΅ Π½Π°ΠΏΡΠ°Π²Π΅Π½ Π·Π° Π΄Π° ΡΠ΅ ΠΎΠ΄ΡΠ΅Π΄ΠΈ ΡΠ°Π·Π»ΠΈΠΊΠ°ΡΠ° Π²ΠΎ Π½ΠΈΠ²ΠΎΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΠΏΠΎΠΌΠ΅ΡΡ Π³ΡΡΠΏΠΈΡΠ΅ ΡΠΎ ΡΠ°Π·Π»ΠΈΡΠ΅Π½ MELD ΡΠΊΠΎΡ, ΠΈ Π·Π° Π΄Π° ΡΠ΅ ΠΎΡΠ΅Π½ΠΈ ΡΠ°Π·Π»ΠΈΠΊΠ°ΡΠ° Π²ΠΎ Π½ΠΈΠ²ΠΎΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΠΊΠ°Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΡΠΎ ΠΏΡΠΈΡΡΡΡΠ²ΠΎ ΠΈΠ»ΠΈ ΠΎΡΡΡΡΡΠ²ΠΎ Π½Π° Π°ΡΡΠΈΡ ΠΈ ΡΠ°Π·Π»ΠΈΠΊΠ°ΡΠ° Π²ΠΎ Π½ΠΈΠ²ΠΎΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΠΊΠ°Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΡΠΎ ΠΈΠ»ΠΈ Π±Π΅Π· ΡΠΏΠΎΠ½ΡΠ°Π½ Π±Π°ΠΊΡΠ΅ΡΠΈΡΠΊΠΈ ΠΏΠ΅ΡΠΈΡΠΎΠ½ΠΈΡΠΈΡ (SBP). Pearson-ΠΎΠ²ΠΈΠΎΡ ΠΊΠΎΠ΅ΡΠΈΡΠΈΠ΅Π½Ρ Π½Π° ΠΊΠΎΡΠ΅Π»Π°ΡΠΈΡΠ° Π±Π΅ΡΠ΅ ΠΊΠΎΡΠΈΡΡΠ΅Π½ Π·Π° Π΄Π° ΡΠ΅ ΠΎΡΠ΅Π½ΠΈ ΠΊΠΎΡΠ΅Π»Π°ΡΠΈΡΠ°ΡΠ° ΠΏΠΎΠΌΠ΅ΡΡ Π½ΠΈΠ²ΠΎΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈ ΡΠΎ MELD ΡΠΊΠΎΡΠΎΡ ΠΈ ΠΊΠΎΡΠ΅Π»Π°ΡΠΈΡΠ°ΡΠ° ΠΏΠΎΠΌΠ΅ΡΡ Π½ΠΈΠ²ΠΎΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈ ΠΈ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡΠ°ΡΠ° Π½Π° Π±ΠΈΠΎΡ
Π΅ΠΌΠΈΡΠΊΠΈ, ΠΊΠ»ΠΈΠ½ΠΈΡΠΊΠΈ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΈ ΠΈ ΠΊΠΎΠΌΠΏΠ»ΠΈΠΊΠ°ΡΠΈΠΈ ΠΏΠΎΠ²ΡΠ·Π°Π½ΠΈ ΡΠΎ ΡΡΠ½ΠΎΠ΄ΡΠΎΠ±Π½Π° ΡΠΈΡΠΎΠ·Π°. Π Π΅Π·ΡΠ»ΡΠ°ΡΠΈ: ΠΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΡΠ΅ Π·Π³ΠΎΠ»Π΅ΠΌΠΈ ΡΠΎ ΡΠ΅ΠΆΠΈΠ½Π°ΡΠ° Π½Π° Π±ΠΎΠ»Π΅ΡΡΠ° ΠΏΡΠΎΡΠ΅Π½Π΅ΡΠ° ΡΠΎ CTP ΠΈ MELDΡΠΊΠΎΡΠΎΡ ΡΠΎ ΡΡΠ°ΡΠΈΡΡΠΈΡΠΊΠΈ Π·Π½Π°ΡΠ°ΡΠ½Π° ΡΠ°Π·Π»ΠΈΠΊΠ° ΠΏΠΎΠΌΠ΅ΡΡ Π³ΡΡΠΏΠΈΡΠ΅ (p=,0000 ΠΈ p=,0001, ΡΠΎΠΎΠ΄Π²Π΅ΡΠ½ΠΎ). ΠΡΡΠΏΠ°ΡΠ° CTP-C ΠΏΠΎΠΊΠ°ΠΆΠ° Π½Π°ΡΠ²ΠΈΡΠΎΠΊΠ° ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈ, ΠΏΠΎ ΡΡΠΎ ΡΠ»Π΅Π΄ΡΠ²Π°Π° Π³ΡΡΠΏΠΈΡΠ΅ Π ΠΈ Π. ΠΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅ ΡΠΎ SBP ΠΈΠΌΠ°Π° Π·Π½Π°ΡΠΈΡΠ΅Π»Π½ΠΎ ΠΏΠΎΠ²ΠΈΡΠΎΠΊΠ° ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈ Π²ΠΎ ΡΠΏΠΎΡΠ΅Π΄Π±Π° ΡΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅ Π±Π΅Π· SBP (p= ,0006). ΠΠ΅ΡΠ΅ ΡΡΠ²ΡΠ΄Π΅Π½Π° Π·Π½Π°ΡΠΈΡΠ΅Π»Π½Π° ΠΏΠΎΠ·ΠΈΡΠΈΠ²Π½Π° ΠΊΠΎΡΠ΅Π»Π°ΡΠΈΡΠ° ΠΏΠΎΠΌΠ΅ΡΡ Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΠΈ CTP ΠΈ MELD ΡΠΊΠΎΡΠΎΡ (ΠΊΠΎΠ΅ΡΠΈΡΠΈΠ΅Π½Ρ Π½Π° ΠΊΠΎΡΠ΅Π»Π°ΡΠΈΡΠ° r= 0,74 ΠΈ r= 0,44, ΡΠΎΠΎΠ΄Π²Π΅ΡΠ½ΠΎ; p< ,001). ΠΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»Π½ΠΎ, ΡΠ΅Π·ΡΠ»ΡΠ°ΡΠΈΡΠ΅ ΠΏΠΎΠΊΠ°ΠΆΠ°Π° Π΄Π΅ΠΊΠ° ΠΏΠΎΡΡΠΎΠΈ ΠΏΠΎΠ²ΡΠ·Π°Π½ΠΎΡΡ ΠΌΠ΅ΡΡ ΠΏΠ»Π°Π·ΠΌΠ° ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΡΠΎ ΠΊΠ»ΠΈΠ½ΠΈΡΠΊΠΈΡΠ΅ ΠΈ Π±ΠΈΠΎΡ
Π΅ΠΌΠΈΡΠΊΠΈ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΈ ΠΊΠΎΠΈ ΠΊΠ°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΠΈΡΠ°Π°Ρ ΠΏΡΠΎΠ³ΡΠ΅ΡΠΈΠ²Π½Π° Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΡΠ° Π½Π° ΡΡΠ½ΠΈΠΎΡΠ΄ΡΠΎΠ±. ΠΠ΄ ΡΠΈΡΠ΅ ΠΈΡΠΏΠΈΡΡΠ²Π°Π½ΠΈ Π±ΠΈΠΎΡ
Π΅ΠΌΠΈΡΠΊΠΈ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΈ, Π½Π°ΡΠ²ΠΈΡΠΎΠΊΠ° ΡΡΠ°ΡΠΈΡΡΠΈΡΠΊΠΈ Π·Π½Π°ΡΠΈΡΠ΅Π»Π½Π° ΠΊΠΎΡΠ΅Π»Π°ΡΠΈΡΠ° Π±Π΅ΡΠ΅ ΡΡΠ²ΡΠ΄Π΅Π½Π° ΠΌΠ΅ΡΡ Π½ΠΈΠ²ΠΎΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΠΈ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡΠ°ΡΠ° Π½Π° ΡΠ΅ΡΡΠΌΡΠΊΠΈΡΠ΅ Π°Π»Π±ΡΠΌΠΈΠ½ΠΈ (r = - 0,65, p< 0,001). ΠΠ°ΠΊΠ»ΡΡΠΎΠΊ: ΠΠ»Π°Π·ΠΌΠ°ΡΡΠΊΠ°ΡΠ° ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ Π΅ ΡΠ΅ΡΠ½ΠΎ ΠΏΠΎΠ²ΡΠ·Π°Π½Π° ΡΠΎ ΡΡΠ΅ΠΏΠ΅Π½ΠΎΡ Π½Π° Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΡΠ° Π½Π° ΡΡΠ½ΠΈΠΎΡΠ΄ΡΠΎΠ± ΠΈ ΠΊΠΎΠΌΠΏΠ»ΠΈΠΊΠ°ΡΠΈΠΈΡΠ΅ ΠΏΠΎΠ²ΡΠ·Π°Π½ΠΈ ΡΠΎ ΡΠΈΡΠΎΠ·Π° Π½Π° ΡΡΠ½ Π΄ΡΠΎΠ±. ΠΠ°ΡΠΎΠ°, Π½ΠΈΠ²ΠΎΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΠΌΠΎΠΆΠ΅ Π΄Π° ΡΠ΅ ΠΊΠΎΡΠΈΡΡΠ°Ρ ΠΊΠ°ΠΊΠΎ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠΊΠΈ ΠΌΠ°ΡΠΊΠ΅Ρ Π·Π° ΡΡΡΠ°ΡΠΈΡΠΈΠΊΠ°ΡΠΈΡΠ° ΠΈ Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»Π΅Π½ Π΄ΠΈΡΠ°Π³Π½ΠΎΡΡΠΈΡΠΊΠΈ ΠΌΠ°ΡΠΊΠ΅Ρ Π²ΠΎ ΠΊΠΎΠΌΠΏΠ»ΠΈΠΊΠ°ΡΠΈΠΈΡΠ΅ ΠΏΠΎΠ²ΡΠ·Π°Π½ΠΈ ΡΠΎ ΡΠΈΡΠΎΠ·Π° Π½Π° ΡΡΠ½ Π΄ΡΠΎΠ±