维生素K1治疗肝衰竭凝血功能障碍的研究进展

熊壮; 刘扬扬; 霍少凯; 宫嘉莲; 金天一; 王强; 王慧林; 刘铁军; 冷炎

doi:10.3969/j.issn.1001-5256.2019.09.048

维生素K1治疗肝衰竭凝血功能障碍的研究进展

DOI: 10.3969/j.issn.1001-5256.2019.09.048

1. 长春中医药大学附属医院肝脾胃病科
2. 长春中医药大学附属医院内分泌科
3. 长春中医药大学

基金项目:

国家自然科学基金项目(81804007)；吉林省科技厅项目(20190304075YY)；长春中医药大学培育基金项目(2018KJ04)；

详细信息

中图分类号: R575.3
计量
- 文章访问数: 1639
- HTML全文浏览量: 47
- PDF下载量: 281
- 被引次数: 0
出版历程
- 收稿日期: 2019-05-23
- 出版日期: 2019-09-20

Research advances in vitamin K1 in treatment of coagulopathy of liver failure

Department of Hepatology and Gastroenterology, The Affiliated Hospital of Changchun University of Chinese Medicine

Research funding:

摘要

摘要: 肝衰竭是多种因素引起的肝脏损害,而维生素K1治疗肝衰竭凝血功能障碍一直存在争议。回顾了各国肝衰竭诊疗指南以及维生素K1治疗肝病凝血功能障碍的文献,分析得出盲目应用维生素K1不能改善肝病患者凝血功能,但肝衰竭时维生素K缺乏且伴有凝血功能障碍时,应用维生素K1可能是必要的。另外,胆汁淤积状态可作为独立因素考虑,但有待于进一步验证。
- 肝功能衰竭 /
- 维生素K1 /
- 血液凝固
Abstract: Liver failure is a type of liver injury caused by a variety of factors, and there are still controversies over the clinical effect of vitamin K1 in the treatment of coagulopathy of liver failure. This article reviews the guidelines for the diagnosis and treatment of liver failure in various countries and the articles on vitamin K1 in the treatment of coagulopathy of liver diseases. It is concluded that blind application of vitamin K1 cannot improve the coagulation function of patients with liver disease; however, vitamin K1 is necessary for patients with vitamin K deficiency and coagulopathy during liver failure. In addition, the state of cholestasis may be considered an independent factor, but further studies are needed for verification.
- liver failure /
- vitamin K1 /
- blood coagulation

HTML全文

参考文献(45)

[1] PEREIRA SP, ROWBOTHAM D, FITT S, et al. Pharmacokinetics and efficacy of oral versus intravenous mixed-micellar phylloquinone (vitamin K1) in severe acute liver disease[J].J Hepatol, 2005, 42 (3) :365-370.

[2] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guidelines for diagnosis and treatment liver failure[J]. Chin J Clin Infect Dis, 2012, 5 (6) :321-327. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南 (2012年版) [J].中华临床感染病杂志, 2012, 5 (6) :321-327.

[3] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure (2018) [J]. J Clin Hepatol, 2019, 35 (1) :38-44. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南 (2018年版) [J].临床肝胆病杂志, 2019, 35 (1) :38-44.

[4] MENG QH, DUAN ZH. Interpretation of American Association for the Study of Liver Diseases Position Paper on acute liver failure 2011[J/CD]. Chin J Front Med Sci:Electronic Version, 2013, 5 (1) :61-69. (in Chinese) 孟庆华, 段忠辉. 2011美国肝病研究学会急性肝衰竭处理立场声明解读[J/CD].中国医学前沿杂志:电子版, 2013, 5 (1) :61-69.

[5] YANG M, ZHANG SG, LU MQ. EASL clinical practical guidelines on the management of acute (fulminant) liver failure (2017) [J]. J Clin Hepatol, 2017, 33 (10) :1883-1887. (in Chinese) 杨敏, 张盛果, 卢明芹.《2017年欧洲肝病学会临床实践指南:急性 (暴发性) 肝衰竭的管理》摘译[J].临床肝胆病杂志, 2017, 33 (10) :1883-1887.

[6] NING HB, SHANG J. Coagulation disorders in patients with liver cirrhosis[J]. J Clin Hepatol, 2016, 32 (6) :1083-1085. (in Chinese) 宁会彬, 尚佳.肝硬化患者凝血功能障碍的探讨[J].临床肝胆病杂志, 2016, 32 (6) :1083-1085.

[7] ZHU P. Research advances in coagulation disorder in liver cirrhosis[C]//Study Group of Viral Hepatitis, Chinese Society of Infectious Diseases, Chinese Medical Association; Institute of Infectious Diseases, Third Military Medical University. Collected Papers from the Second National Symposium for Chronicity&Severity of Viral Hepatitis. Chongqing, 2012:6. (in Chinese) 朱鹏.肝衰竭的凝血功能障碍研究进展[C]//中华医学会感染病学分会病毒性肝炎学组, 第三军医大学全军感染病研究所.第二届全国病毒性肝炎慢性化重症化基础与临床研究进展学术会议论文汇编.重庆, 2012:6.

[8] BONOMO RA, SZABO D. Mechanisms of multidrug resistance in Acinetobacter species and Pseudomonas aeruginosa[J].Clin Infect Dis, 2006, 43 (Suppl 2) :s49-s56.

[9] LI L, SUN XG, GENG P. Advances in the clinical application of vitamin K1[J]. Chinese J Coal Industry Med, 2011, 14 (6) :941-942. (in Chinese) 李力, 孙孝国, 耿萍.维生素K1的临床应用进展[J].中国煤炭工业医学杂志, 2011, 14 (6) :941-942.

[10] WANG H, GUO LY, LI GC, et al. Clincal analysis of acquired deficiencies of vitamin K-dependent coagulation factors[J].J Qiqihar Med Univ, 2007, 28 (11) :1287-1288. (in Chinese) 王浩, 郭丽英, 李罡灿, 等.获得性维生素K依赖性凝血因子缺乏症21例临床分析[J].齐齐哈尔医学院学报, 2007, 28 (11) :1287-1288.

[11] XI XF, ZHU JH, ZOU H, et al. Etiology and treatment:Analysis of acquired deficiencies of vitamin K-dependent coagulation factors[J]. Chin J Med, 2009, 44 (4) :33-35. (in Chinese) 席晓芳, 朱继红, 邹红, 等.获得性维生素K依赖性凝血因子缺乏症的病因和治疗探讨[J].中国医刊, 2009, 44 (4) :33-35.

[12] CAO Y, ZHAO F, LI HL, et al. Significance of the change in prothrombin activity after vitamin K correction in patients with severe liver diseases[J]. Chin J Misdiagn, 2006, 7 (10) :1896-1897. (in Chinese) 曹毅, 赵芳, 李鸿林, 等.严重肝病维生素K纠正试验后凝血酶原活动度变化的意义[J].中国误诊学杂志, 2006, 7 (10) :1896-1897.

[13] LI HL, WANG J. ZHANG XR. Change in prothrombin activity after vitamin K correction in patients with severe liver diseases[J]. Chinese J Coal Industry Med, 2004, 7 (10) :966-967. (in Chinese) 李鸿林, 王婕, 张兴荣.严重肝病患者维生素K纠正试验后凝血酶原活动度的变化[J].中国煤炭工业医学杂志, 2004, 7 (10) :966-967.

[14] LI LJ, JIANG ZQ, WANG QJ. Changes in prothrombin time and platelet parameter after vitamin K treatment in patients with liver cirrhosis[J]. J Military Surg Southwest China, 2009, 11 (5) :860-861. (in Chinese) 李丽娟, 江泽琴, 王启军.肝硬化患者维生素K治疗后凝血酶原时间与血小板参数变化的探讨[J].西南军医, 2009, 11 (5) :860-861.

[15] ZHOU JQ, LI D. Prolonged prothrombin time caused by liver cirrhosis and vitamin K absence[J]. Clin Misdiagn Misther, 2005, 18 (11) :853-854. (in Chinese) 周俊卿, 李东.肝硬化合并维生素K缺乏致凝血酶原时间延长[J].临床误诊误治, 2005, 18 (11) :853-854.

[16] SAJA MF, ABDO AA, SANAI FM, et al. The coagulopathy of liver disease:does vitamin K help?[J]. Blood Coagul Fibrinolysis, 2013, 24 (1) :10-17.

[17] OTERO FM, ROMERO-GOMEZ M, MARTINEZ DC, et al.Usefulness of vitamin K in hepatic cirrhosis[J]. Aten Primaria, 1999, 24 (4) :242-243.

[18] STROPLE J, LOVELL G, HEUBI J. Prevalence of subclinical vitamin K deficiency in cholestatic liver disease[J]. J Pediatr Gastroenterol Nutr, 2009, 49 (1) :78-84.

[19] AKIMOTO T, HAYASHI N, ADACHI M, et al. Viability and plasma vitamin K levels in the common bile duct-ligated rats[J]. Exp Anim, 2005, 54 (2) :155-161.

[20] KOWDLEY KV, EMOND MJ, SADOWSKI JA, et al. Plasma vitamin K1 level is decreased in primary biliary cirrhosis[J]. Am J Gastroenterol, 1997, 92 (11) :2059-2061.

[21] MAGER DR, MCGEE PL, FURUYA KN, et al. Prevalence of vitamin K deficiency in children with mild to moderate chronic liver disease[J]. J Pediatr Gastroenterol Nutr, 2006, 42 (1) :71-76.

[22] MAHADEVAN SB, BEATH SV, MCKIERNAN PJ, et al. The vitamin K debacle and infants with cholestatic liver disease[J].Arch Dis Child, 1999, 81 (3) :281.

[23] NAMBU M, LIJIMA T. A combination therapy of vitamin K1 and bile acid on hemorrhagic diathesis in patients with decompensated liver cirrhosis[J]. Gastroenterol Jpn, 1988, 23 (2) :160-164.

[24] MAO Q. Pathogenesis and management strategies of liver failure-associated cholestasis[J]. J Clin Hepatol, 2019, 35 (2) :258-261. (in Chinese) 毛青.肝衰竭时胆汁淤积的发生机制及处置对策[J].临床肝胆病杂志, 2019, 35 (2) :258-261.

[25] CHEN Q. The role of vitamin K1 in prevention of postpartum hemorrhage of intrahepatic cholestasis of pregnancy[J]. J Bengbu Med Col, 2002, 27 (6) :498-499. (in Chinese) 陈倩.维生素K1预防妊娠期肝内胆汁淤积症产后出血[J].蚌埠医学院学报, 2002, 27 (6) :498-499.

[26] CUI AP. Association between vitamin K supplementation and postpartum blood loss in patients with intrahepatic cholestasis of pregnancy:An analysis of 289 cases[J]. Acta Univ Med Nanjing, 2000, 20 (6) :492. (in Chinese) 崔爱平.妊娠期肝内胆汁瘀积症289例补充维生素K与产后出血量的关系[J].南京医科大学学报, 2000, 20 (6) :492.

[27] RIVOSECCHI RM, KANE-GILL SL, GARAVAGLIA J, et al.The effectiveness of intravenous vitamin K in correcting cirrhosis-associated coagulopathy[J]. Int J Pharm Pract, 2017, 25 (6) :463-465.

[28] MEYER AV, GREEN M, PAUTLER HM, et al. Impact of vitamin K administration on INR changes and bleeding events among patients with cirrhosis[J]. Ann Pharmacother, 2016, 50 (2) :113-117.

[29] DOUVRES PA. Effect of high parenteral doses of vitamin-K analogs and serum albumin on the prothrombin level and liver function in alcoholic cirrhosis[J]. Am J Dig Dis, 1965, 10 (7) :635-642.

[30] LIU ZL, LANG YQ, CHEN CY, et al. The quantitative analysis of vitamin K1 in human serum by isotope dilution liquid chromatography tandem mass spectrometry[J]. Chin J Clin Lab Sci, 2018, 36 (6) :415-417. (in Chinese) 刘占利, 朗亚琴, 陈从艳, 等.同位素稀释超高效液相色谱-串联质谱法检测人血清中维生素K1含量[J].临床检验杂志, 2018, 36 (6) :415-417.

[31] ZHANG YY, BAI L. Clinical evidence for vitamin K1 in preventing bleeding in patients with liver cirrhosis[J]. J Mol Imaging, 2014, 37 (3) :197-200. (in Chinese) 张园园, 白岚.肝硬化患者使用维生素K1预防出血的临床证据[J].分子影像学杂志, 2014, 37 (3) :197-200.

[32] HU JF, JIANG LH, TANG LP. Application of vitamin K1 in patients with decompensated cirrhosis[J]. Pract Clin Med, 2010, 11 (12) :19-20. (in Chinese) 胡锦芳, 蒋丽华, 汤莉萍.维生素K1在肝硬化失代偿期患者中的应用[J].实用临床医学, 2010, 11 (12) :19-20.

[33] BRUYNZEEI I, HEBEDA CL, FOLKERS E, et al. Cutaneous hypersensitivity reactions to vitamin K:2 case reports and a review of the literature[J]. Contact Dermatitis, 1995, 32 (2) :78-82.

[34] LEMLICH G, GREEN M, PHELPS R, et al. Cutaneous reactions to vitamin K1 injections[J]. J Am Acad Dermatol, 1993, 28 (2 Pt 2) :345-347.

[35] TUPPAL R, TREMAINE R. Cutaneous eruption from vitamin K1injection[J]. J Am Acad Dermatol, 1992, 27 (1) :105-106.

[36] ZHANG F, LI Y, WANG HZ, et al. An analysis of adverse reactions of vitamin K1 in patients with liver diseases[J]. J World Latest Med Inf, 2018, 18 (30) :114-116. (in Chinese) 张锋, 李艳, 王会哲, 等.维生素K1用于肝病中的不良反应分析[J].世界最新医学信息文摘, 2018, 18 (30) :114-116.

[37] ZHANG YQ, FANG X. Adverse events due to intravenously injected vitamin K1 in patients with liver cirrhosis[J]. Chin Hepatol, 2014, 19 (12) :993-995. (in Chinese) 张月琴, 方兴.肝硬化患者静脉注射维生素K1致不良反应发生[J].肝脏, 2014, 19 (12) :993-995.

[38] CHEN L, CHEN HL, WANG Y, et al. Study on adverse drug reactions associated with vitamin K1 injection in cirrhotic patients[J]. J Clin Exp Med, 2012, 11 (18) :1434-1436. (in Chinese) 陈励, 陈红廉, 王宇, 等.肝硬化患者注射维生素K1后不良反应10例分析[J].临床和实验医学杂志, 2012, 11 (18) :1434-1436.

[39] CHEN H, DUAN MX. Treatment and analysis of adverse reactions related to vitamin K1 in patients with liver diseases[J].Chin Community Doct, 2009, 11 (19) :228-229. (in Chinese) 陈虹, 段梅欣.维生素K1用于肝病中不良反应的处理及分析[J].中国社区医师, 2009, 11 (19) :228-229.

[40] WANG Y, BAI H, LIU Y. Analysis of adverse reactions related to vitamin K1 in patiets with liver disease[J]. J Ningxia Med Coll, 2008, 30 (4) :515-516. (in Chinese) 王煜, 白慧, 刘娅.维生素K1用于肝病中的不良反应分析[J].宁夏医学院学报, 2008, 30 (4) :515-516.

[41] SOUSA T, HUNTER L, PETITT M, et al. Letter:Localized cutaneous reaction to intramuscular vitamin K in a patient with acute fatty liver of pregnancy[J]. Dermatol Online J, 2010, 16 (12) :16.

[42] LEE MM, GELLIS S, DOVER JS. Eczematous plaques in a patient with liver failure. Fat-soluble vitamin K hypersensitivity[J]. Arch Dermatol, 1992, 128 (2) :257, 260.

[43] BULLEN AW, MILLER JP, CUNLIFFE WJ, et al. Skin reactions caused by vitamin K in patients with liver disease[J]. Br J Dermatol, 1978, 98 (5) :561-565.

[44] BARNES HM, SARKANY I. Adverse skin reaction from vitamin K1[J]. Br J Dermatol, 1976, 95 (6) :653-656.

[45] AIDRICH SM, REGAI RE. Routine use of vitamin K in the treatment of cirrhosis-related coagulopathy:Is it A-O-K? Maybe not, we say[J]. P T, 2019, 44 (3) :131-136.

施引文献

资源附件(0)

访问统计