止血与凝血指标在乙肝与肝硬化及肝脏衰竭患者中的改变规律研究

Changing characteristic of hemostasis and coagulation in patients with hepatitis B, cirrhosis or liver failure

摘要:

目的  探讨不同止凝血指标在乙肝、肝硬化及肝衰竭患者中的变化规律。方法  选取2014年1～12月于该院治疗的69例乙肝患者和同期30例健康体检者为研究对象。乙肝患者根据病情分为慢性乙肝组（23例）、肝硬化组（26例）及肝衰竭组（20例）。检测所有入组患者的凝血功能指标，主要包括凝血酶原时间（PT）、凝血酶原活动度（PTA）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）及纤维蛋白原（Fg），检测不同组患者的抗凝指标（PC和AT-Ⅲ）、纤溶降解产物（FDP和D-D）及内皮细胞产生的组织因子途径抑制物（TFPI）、组织因子（TF）及血栓调节蛋白（TM），比较不同凝血指标在各肝脏疾病中的变化。结果 PT、APTT及TT在肝硬化组及肝衰竭组显著延长，而PTA及Fg显著下降，差异有统计学意义（P <0.05）。在肝硬化患者中，随着肝功能下降，患者PT、APTT及TT延长，PTA和Fg下降（P <0.05）。与HBV-DNA阴性患者比较，HBV-DNA阳性患者的PT、APTT及TT显著延长，而PTA和Fg明显下降（P <0.05）。常见的抗凝指标PC：A及AT-Ⅲ：A在不同肝病中差异有统计学意义（P <0.05），纤溶降解产物FDP及D-D随着病情的进展逐渐增高（P < 0.05）。内皮细胞合成的凝血功能相关指标TFPI:Ag及TF:Ag在慢性乙肝、肝硬化及肝衰竭患者中差异有统计学意义（P <0.05）；与健康对照组比较，各肝病组患者TM:Ag水平显著升高，差异有统计学意义（P <0.05）。结论  随着肝脏疾病的进展，患者的凝血障碍逐渐加重，抗凝及纤溶活性增强，止凝血指标的检测对了解患者肝脏的损害程度、出凝血功能状况、出血倾向有着重要的意义。

Abstract:

Objective To investigate the changing characteristic of hemostasis and coagulation in patients with hepatitis B, cirrhosis and liver failure. Methods A number of 69 patients with hepatitis B and 30 healthy volunteers, from January 2014 to 2014 December in our hospital were selected for the study. According to the patients' condition, they were divided into chronic hepatitis B group (23), cirrhosis group (26) and liver failure group (20). Coagulation parameters were detected, including prothrombin time (PT), prothrombin activity (PTA), activated partial thromboplastin time (APTT), thrombin time (TT) and fibrinogen (Fg). Anticoagulation (PC and AT-Ⅲ), fibrinolysis degradation products (FDP and DD), tissue factor pathway inhibitor (TFPI), tissue factor (TF) and thrombomodulin protein (TM) were compared in different groups. Results Compared with the healthy control group and the chronic hepatitis group, PT, APTT and TT were significantly extended in cirrhosis group and liver failure group, and PTA and Fg were significantly decreased (P < 0.05); With liver function deteriorating, the cirrhosis patients' PT, APTT and TT were prolonged, and PTA and Fg were decreased (P < 0.05). Compared with the HBV-DNA negative patients, PT, APTT and TT were significantly prolonged, and PTA and Fg were decreased significantly in HBV-DNA positive patients (P < 0.05 ). Common anticoagulation PC: A and AT-Ⅲ: A had a significant difference(P < 0.05) in different liver disease. Fibrinolysis degradation products FDP and DD as the disease progresses were gradually increased (P < 0.05). TFPI: Ag and TF: Ag in chronic hepatitis group, cirrhosis group and liver failure group were significantly different (P < 0.05). Compared with the healthy control group, TM: Ag in patients with various liver diseases was significantly increased (P < 0.05 ). Conclusions  During the progression of liver diseases, blood clotting disorders are getting worse and anticoagulant and fibrinolytic activity is enhanced, which help doctors to assess the severity of liver cirrhosis and understand blood coagulation status, bleeding tendency and thrombophilia in patients with liver cirrhosis.