肝硬化患者血栓调节蛋白、抗凝及纤溶系统的变化与Child-Pugh分级的关系

The relationship between the level of thrombomodulin,anticoagulation and fibrinolytic index in liver cirrhosis patients and Child-Pugh grading

目的探讨肝硬化患者血栓调节蛋白（TM）、抗凝及纤溶系统指标的变化及其与Child-Pugh分级的关系。方法肝硬化患者77例，按Child-Pugh分级进行分组：A级组12例，B级组32例，C级组33例；对照组20例。均检测TM、抗凝血酶-Ⅲ（AT-Ⅲ）、蛋白-C（PC）、蛋白-S（PS）、D-二聚体、组织纤溶酶原激活物（t-PA）和纤溶酶原激活物抑制剂-1（PAI-1）。结果在对照组、A级组、B级组、C级组中，TM随病情加重而升高，分别为（4．24±0．81）μg／L、（4．36±2．56）μg／L、（6．66±3．30）μg／L、（6．79±3．69）μg／L；AT-Ⅲ随病情加重而逐渐降低，分别为（102．35±8．12）％、（105．46±8．71）％、（102．09±8．39）％、（94．32±9．85）％；PC和PS随病情加重而有逐渐减低的趋势；D-二聚体随病情加重而逐渐增高，分别为（0．27±0．13）mg／L、（0．42±0．26）mg／L、（0．79±0．35）mg／L、（0．93±0．43）mg／L；t-PA和PAI-1随肝功能恶化而变化的现象不明显。结论肝硬化患者的TM、抗凝和纤溶系统指标存在明显的异常且和Child-Pugh分级相关。检测以上指标有助于对肝功能损害程度及预后的判断。

Objective To investigate the relationship between the level of thrombomodulin （TM）, anticoagulation and fibrinolytic index in liver cirrhosis patients and Child-Pugh grading. Methods In reference to Child-Pugh grading 77 patients with liver cirrhosis were divided into three groups. Among the patients, 12 were classified as Child-Pugh class A （A group） ,32 and 33 were classified as class B （B group） and C （C group） respectively. Twenty healthy people were recruited in control group. Assays including TM, antithrombin-Ⅲ （ AT-Ⅲ ）, protein-C （ PC ）, protein-S （ PS ）, D-dimer, tissue plasminogen activator （ t-PA ）, and plasminogen activator inhibitor-1 （PAI-1） were measured. Results TM progressively increased in control group （4.24 ± 0.81 ） μg/L, A group （4.36 ± 2.56） μg/L, B group （6.66 ± 3.30） μg/L and C group （6.79 ± 3.69）μg/L. AT-Ⅲ decreased progressively with the severity of the disease,it was （102.35 ± 8.12 ）%, （ 105.46± 8.71 ）%, （ 102.09 ± 8.39）% and （94.32 ± 9.85 ）% respectively. PC and PS decreased progressively . D-dimer also increased progressively with the severity of the disease, it was （0.27 ± 0.13 ） mg/L, （ 0.42 ± 0.26 ）mg/L, （ 0.79 ± 0.35 ）mg/L, （ 0.93 ± 0.43 ）mg/L respectively. PAI-1 and t-PA activity did not show significant changes in the four groups. Conclusions The changes of TM, anticoagulation and fibrinolytic system in liver cirrhosis patients are determined and the changes are relative to Child-Pugh grading. These indices can help to judge the degree of liver function disorder and prognosis.