乙型肝炎患者凝血功能与临床分型的关系

Relationship between coagulative function and the clinical classification of patients with hepatitis B

目的探讨乙型肝炎患者凝血功能在不同临床分型中的变化与意义。方法乙型肝炎患者486例,健康人群50例,分别检测凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)及血清HBV、DNA含量。分析PT、APTT、FIB等凝血功能指标在乙肝不同临床分型中的变化。结果除慢性乙型肝炎(轻度)组的PT值与对照组无差异外,其余各组乙型肝炎与对照组比较差异均有显著性意义(P<0.05或P<0.01),乙型肝炎各组APTT值与对照组比较差异均有显著性意义(P<0.05或P<0.01),慢性乙型肝炎(重度)和乙型肝炎后肝硬化组FIB与对照组比较有极显著性差异(P<0.01),而急性乙型肝炎、慢性乙型肝炎(轻、中度)组FIB与对照组比较差异无显著性意义(P>0.05);慢性乙型肝炎及肝硬化的严重程度与PT、APTT值呈正相关,与FIB值有极弱相关性。结论慢性乙型肝炎患者凝血功能异常程度随病情而加重,FIB是监测慢性乙型肝炎患者向重度或肝硬化发展的重要指标。

Objective To study the coagulative function changes in hepatitis B patients of different clinical classifica- tion. Methods A total of 486 patients with hepatitis B and 50 healthy individuals served as control were enrolled. Prothrombin time （PT） , active partial thromboplastin time （APTT） , fibrinogen （FIB） , the serum content of HBV and DNA were measured. Then all parameters of coagulative function were analyzed on the basis of the different classifications of hepatitis B. Results Except chronic hepatitis B patients （mild degree） whose PT values were not significantly different with controls, the PT and ARTT of other patients were higher than the controls （P 〈 0. 05 or P 〈 0. 01 ）. FIB in severe chronic hepatitis B and cirrhosis patients was significantly different with that of controls （ P 〈 0. 01 ） , but it failed to show significant difference between mild or moderate hepatitis B patients and controls. There was positive correlation between PT or ARTT levels and the severity of chronic hepatitis B and cirrhosis, but slight correlation between FIB and the severity. Conclusion The coagulative function of chronic hepatitis B patients will exacerbate along with the aggravation of the disease. FIB is an important index to predict the aggravation of the disease from chronic hepatitis B to severe chronic hepatitis B or cirrhosis.