乙型肝炎肝硬化患者促凝和抗凝血因子变化分析

邓永东; 彭雪彬; 姚立琼; 李海; 谭榜云; 马超群

doi:10.3969/j.issn.1001-5256.2019.02.020

乙型肝炎肝硬化患者促凝和抗凝血因子变化分析

DOI: 10.3969/j.issn.1001-5256.2019.02.020

1. 兰州大学第一医院
2. 兰州大学第一临床医学院

基金项目:

甘肃省科技计划资目——甘肃省自然科学基金(17JR5RA270)；

详细信息

中图分类号: R512.62;R575.2
计量
- 文章访问数: 1814
- HTML全文浏览量: 65
- PDF下载量: 291
- 被引次数: 0
出版历程
- 收稿日期: 2018-09-20
- 出版日期: 2019-02-20

Changes in procoagulant and anticoagulant factors in patients with hepatitis B cirrhosis

The First Hospital of Lanzhou University

Research funding:

摘要

摘要: 目的了解乙型肝炎肝硬化患者的促凝、抗凝血因子以及临床常规凝血指标的变化,明确其临床意义。方法选取2017年1月-2018年10月于兰州大学第一医院感染科门诊及住院的乙型肝炎肝硬化患者105例,根据Child-Pugh分级分为3组:A级组（n=42）、B级组（n=39）、C级组（n=24）,对所有患者检测常用临床凝血指标如凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）,凝血因子（Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅺ）,抗凝血因子抗凝血酶（AT）、蛋白C（PC）、游离蛋白S（FPS）。计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验,相关性分析采用Spearman相关分析法。结果不同Child-Pugh分级的乙型肝炎肝硬化患者PT、APTT差异均有统计学意义（F值分别为55. 11、12. 09,P值均<0. 001）,C级组均显著高于B级和A级组,B级组均显著高于A级组（P值均<0. 05）。凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅺ活性在不同Child-Pugh分级的乙型肝炎肝硬化患者中差异均有统计学意义（F值分别为32. 52、14. 77、38. 88、9. 24,P值均<...
- 肝炎,乙型 /
- 肝硬化 /
- 血液凝固因子 /
- 抗凝血酶类
Abstract: Objective To investigate the changes in procoagulant and anticoagulant factors and routine coagulation markers in patients with hepatitis B cirrhosis and their clinical significance. Methods A total of 105 patients with hepatitis B cirrhosis who were admitted to Department of Infectious Diseases in The First Hospital of Lanzhou University from January 2017 to October 2018 were enrolled, and according to the Child-Pugh class, these patients were divided into group A ( 42 patients with Child-Pugh class A cirrhosis) , group B ( 39 patients with Child-Pugh class B cirrhosis) , and group C ( 24 patients with Child-Pugh class C cirrhosis) . Routine coagulation markers including prothrombin time ( PT) and activated partial prothrombin time ( APTT) , blood coagulation factors ( Ⅱ, Ⅴ, Ⅶ, Ⅷ, and Ⅺ) , anti-thrombin ( AT) , protein C ( PC) , and free protein S ( FPS) were measured for all patients. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups; a Spearman correlation analysis was also performed. Results There were significant differences in PT and APTT between the three groups ( F = 55. 11 and 12. 09, both P < 0. 001) ; group C had significantly higher PT and APTT than groups A and B, and group B had significantly higher PT and APTT than group A ( all P < 0. 05) . There were significant differences in the activities of blood coagulation factorsⅡ, Ⅴ, Ⅶ, and XI between the three groups ( F = 32. 52, 14. 77, 38. 88, and 9. 24, all P < 0. 001) ; group C had significantly lower activities of these coagulation factors than groups B and A, and group B had significantly lower activities than group A ( all P < 0. 05) . There was a significant difference in the activity of blood coagulation factor Ⅷ between the three groups ( F = 4. 44, P < 0. 05) ; group C had a significantly higher activity than groups A and B ( P < 0. 05) , while there was no significant difference between group A and group B ( P >0. 05) . There were significant differences in the activities of AT, PC, and FPS between the three groups ( F = 25. 90, 30. 46, and 15. 58, all P < 0. 001) ; group C had significantly lower activities than groups B and A, and group B had significantly lower activities than group A ( all P < 0. 05) . The correlation analysis showed that Child-Pugh class was negatively correlated with blood coagulation factors Ⅱ, Ⅴ, Ⅶ, and Ⅺ and anticoagulant factors PC, FPS, and AT ( r =-0. 687, -0. 460, -0. 706, -0. 426, -0. 723, -0. 646, and-0. 468, all P < 0. 001) , and Child-Pugh class had the strongest correlation with blood coagulation factors Ⅱ and Ⅶ and the anticoagulant factor PC.Blood coagulation factors II and Ⅶ were positively correlated with the anticoagulant factor PC ( r = 0. 851 and 0. 745, both P < 0. 001) .Conclusion Patients with hepatitis B cirrhosis have reductions in both procoagulant and anticoagulant factors, and there is a significant correlation between them. An unstable balance may form in the body, which is not considered a conventional hypocoagulable state.
- hepatitis B /
- liver cirrhosis /
- blood coagulation factors /
- antithrombins

HTML全文

参考文献(12)

[1]TSOCHATZIS EA, SENZOLO M, GERMANI G, et al.Systematic review:Portal veinthrombosis in cirrhosis[J].Aliment Pharmacol Ther, 2010, 31 (3) :366-374.

[2]LISMAN T, PORTE RJ.Rebalanced hemostasis in patients with liver disease:Evidence and clinical consequences[J].Blood, 2010, 116 (6) :878-885.

[3]TRIPODI A, ANSTEE QM, SOGAARD KK, et al.Hypercoagulability in cirrhosis:Causes and consequences[J].J Thromb Haemost, 2011, 9 (9) :1713-1723.

[4]AMBROSINO P, TARANTINO L, DI MINNO G, et al.The risk of venous thromboembolism in patients with cirrhosis.A systematic review and meta-analysis[J].Thromb Haemost, 2017, 117 (1) :139-148.

[5]CHEN DF, XIONG J.Advances in mechanisms and treatment of portal vein thrombosis in patients with liver cirrhosis[J].JClin Hepatol, 2017, 33 (3) :451-453. (in Chinese) 陈东风, 熊吉.肝硬化门静脉血栓形成的机制与治疗进展[J].临床肝胆病杂志, 2017, 33 (3) :451-453.

[6]Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J].JClin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960.

[7]FERRO D, ANGELICO F, CALDWELL SH, et al.Bleeding and thrombosis in cirrhotic patients:What really matters?[J].Dig Liver Dis, 2012, 44 (4) :275-279.

[8]CARNEVALE R, RAPARELLI V, NOCELLA C, et al.Gut-derived endotoxin stimulates factor VIII secretion from endothelial cells.Implications for hypercoagulability in cirrhosis[J].JHepatol, 2017, 67 (5) :950-956.

[9]SHOVLIN CL, ANGUS G, MANNING RA, et al.Endothelial cell processing and alternatively spliced transcripts of factor VIII:Potential implications for coagulation cascades and pulmonary hypertension[J].PLo S One, 2010, 5 (5) :e9154.

[10]IKURA Y, OSUGA T.Changing common sense:Anti-platelet/coagulation therapy against cirrhosis[J].World J Hepatol, 2015, 8 (13) :1730-1734.

[11]TRIPODI A.Hemostasis abnormalities in chronic liver failure[M]//GINS P, KAMATH P, ARROYO V.Chronic liver failure.Clinical Gastroenterology.Humana Press, 2011:289-303.

[12]BACCOUCHE H, LABIDI A, FEKIH M, et al.Haemostatic balance in cirrhosis[J].Blood Coagul Fibrinolysis, 2017, 28 (2) :139-144.

施引文献

资源附件(0)

访问统计