肝病患者手术及介入治疗后凝血纤溶指标监测对疗效的评估作用

Research on evaluating the effects of coagulation and fibrinolysis indicators on hepatopathy patients after surgery and interventional therapy

目的探讨肝病患者手术或介入治疗后凝血及纤溶指标的变化对疗效的评估价值。方法对肝病组(100例)、肝癌组(100例)于手术或介入治疗前与后检测血浆凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、抗凝血酶Ⅲ(ATⅢ)活性、蛋白C(PC)活性、蛋白S(PS)活性、纤溶酶原(PLG)活性、组织型纤溶酶原活化物(t-PA)、纤溶酶原活化剂抑制物(PAI)、α2-抗纤溶酶(α2-PI)活性、纤溶酶-纤溶酶抑制物(PAP),并与正常对照组100例比较。结果与对照组比较,肝癌组介入治疗前与后PT、APTT、t-PA、PAI、PAP均明显升高(P<0.05或<0.01),FIB、ATⅢ活性、PC活性、PS活性、PLG活性、α2-PI活性均明显降低(P<0.05或<0.01);与介入治疗前比较,介入治疗后PT、APTT、t-PA降低,FIB、ATⅢ活性、PC活性、PS活性、PLG活性、α2-PI活性升高(P<0.05),而PAI-1和PAP均差异无统计学意义(P>0.05)。与对照组比较,肝病组手术治疗前与后PT、APTT、t-PA、PAP均明显升高(P<0.05或<0.01),而FIB、ATⅢ、PC活性、PS活性、PLG活性、PAI、α2-PI活性降低(P<0.01);与手术治疗前比较,肝病组手术治疗后PT、APTT、t-PA、PAP降低(P<0.05或<0.01),FIB、ATⅢ活性、PC活性、PS活性、PLG活性、PAI、α2-PI活性升高(P<0.05或<0.01)。结论肝病组和肝癌组均存在抗凝活性降低及易发纤溶。手术或介入治疗后有所改善,但未完全恢复正常。

Objective To investigate the evaluating value of curative effect about the hemostatie changes in hepatopathy patients after surgery or interventional therapy. Methods Prothrombin time （PT）,activited partial thromboplastin time （AFTT）,fibrinogen （Fg）,antithrombin-Ⅲ activity （ATⅢ）, protein C activity （PC）, protein S activity （PS）, plasminogen activity （PLG）, tissue-type plasminogen activator （t-PA）, plasminogen activator inhibitor （PAI）, α2 plasmin inhibitor activity （α2-PI）, plasmin-antiplasmin （PAP） level of plasma were measured among hepatopathy groups,liver cancer groups and control groups.Results Compared with control groups, PT,APTT,t-PA,PAI,PAP（P 〈0.05） level of liver cancer groups were significantly elevated at diagnosis,FIB,ATⅢ,PC,PS,PLG,α2-PI（P〈0.01） level of liver cancer groups were significantly decreased; Compared with before interventional therapy ,PT,APTT,t-PA（P〈0.01） ,level of liver cancer groups that after interventional therapy were significantly decreased,Fg,ATⅢ,PC,PS,PLG,α2-PI（P 〈0.05） elevated,PAI-1 and PAP did not display significantly difference. Compared with control groups, PT,APTT,t-PA,PAP（P〈0.05） level of hepatopathy groups were significantly elevated at diagnosis,Fg,ATⅢ,PC,PS,PLG,PAI,α2-PI（P〈0.01） decreaced ,compared with before surgery ,PT,APTT,t-PA,PAP（P〈0.05） level of hepatopathy groups that after surgery decreased,Fg,ATⅢ,PC,PS, PIG,PAI,α2-PI（P〈0.05） level elevated. Conclusion There existed decreasing of anticoagulant activity and elevating of fibrinolysis activity in both hepatopathy groups and liver cancer groups. The situation was improved after surgery and imerventional therapy,but did not recover completely.