国际标准化比值作为肝病患者PT标准化报告方式的可行性探讨

Assessment of validity of INR system as standardized report of prothrombin time for patients with viral hepatitis

目的 评价国际标准化比值 (INR)系统作为肝病患者PT报告方式的可行性。方法 选择病毒性肝病患者 6 1例 ,其中肝炎肝硬化 4 1例 ,慢性重型肝炎 2 0例。 4 0例口服华法林病人做对照组。采用来源不同、ISI值不同的 6种凝血活酶试剂进行PT测定。同时在两组选择INR值相近的患者检测FIB、凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅸ、Ⅹ。结果 肝病组INR结果 ,6种凝血活酶试剂比较差异有显著性 (P <0 .0 5 ) ;而口服抗凝药组INR结果 ,6种试剂比较差异无显著性 (P >0 .0 5 )。在INR值相近的患者中 ,肝病组的FIB、凝血因子Ⅴ、Ⅶ和Ⅹ与口服抗凝药组比较差异有显著性意义 (P <0 .0 1) ;而Ⅱ和Ⅸ因子在两组之间比较差异无显著性 (P >0 .0 5 )。结论 INR系统不适用于肝病患者PT的标准化报告方式。

Objective To assess the validity of INR system as standardized report of prothrombin time for the patients with liver diseases.Methods In this study 61 patients with liver disease (41 with liver cirrhosis and 20 with chronic liver failure) were selected.The patients who were undergoing Warfarin therapy (n=40) were used as control group.PT were measured by using six thromboplastin reagents with different source and different ISI.INR was calculated by using instrument with specific ISI.Fibrinogen, factorsⅡ,Ⅴ,Ⅶ,Ⅸ and Ⅹ were simultaneously measured in patients with liver diseases and control patients with similar INR.Results The INR for each patient with liver disease using the six thromboplastin reagents were significantly different (P<0.05),but the results of control patients were not different (P>0.05).Fibrinogen(P=0.0001),factors Ⅴ(P=0.0001),Ⅶ(P=0.0001)andⅩ(P=0.004)were significantly different between the 2 groups by Mann-Whitney analysis.Factors Ⅱand Ⅸ were not statistically different (P=0.383 and 0.130 respectively).Conclusion The INR system is not valid for comparison of patients with liver diseases,which may be due to different deficient factor associated with liver disease as compared with the patients undergoing orally anticoagulant therapy.