消化性溃疡出血患者血浆凝血因子活性变化及其临床意义

Changes of plasma coagulation factor activity in patients with peptic ulcer bleeding and its clinical significance

目的:通过测定消化性溃疡出血患者血浆8种凝血因子的活性水平,探讨血凝酶制剂在治疗消化性溃疡出血中的价值。方法:收集2013年4月至2015年4月消化性溃疡出血患者147例,分为无贫血、轻度贫血、中度贫血及重度贫血4组,同时收集消化性溃疡不伴出血患者44例及慢性胃炎患者81例,以慢性胃炎组作为对照组。测定各组患者血浆凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅸ、Ⅹ、Ⅺ及Ⅻ的活性及国际标准化比率(international normalized ratio,INR)。结果:与对照组相比,凝血因子Ⅱ、Ⅴ的活性水平在轻度贫血和中度贫血的溃疡出血患者中降低,凝血因子Ⅶ、Ⅹ的活性在轻度贫血、中度贫血及重度贫血的溃疡出血患者中亦降低,而凝血因子Ⅷ、Ⅸ的活性在4组不同程度贫血的溃疡出血患者中均升高。各组患者的INR值均在正常范围内,且差异无统计学意义。结论:凝血因子Ⅷ和Ⅸ活性的升高在消化性溃疡出血时对维持机体正常水平的凝血功能至关重要。

Objective：To investigate the therapeutic value of blood coagulation enzyme in the treatment of peptic ulcer bleeding by determining the activity level of eight plasma coagulation factors in plasma of patients with peptic ulcer bleeding.Methods：A total of 147 cases of peptic ulcer complicated with bleeding from April 2013 to April 2015 were recruited and divided into four groups：no anemia,mild anemia,moderate anemia,and severe anemia.44 cases of peptic ulcer not complicated with bleeding and 81 cases of chronic gastritis were also recruited and the chronic gastritis cases were used as the control group.We determined the activity levels of the eight plasma coagulation factors：Ⅱ,Ⅴ,Ⅶ,Ⅷ,Ⅸ,Ⅹ,Ⅺ,Ⅻ,and the value of international normalized ratio（INR）in each group.Results：The INR value of each group was within the normal range,and there was no significant difference between the groups.Compared with the control group,the activity levels of coagulation factorsⅡ and Ⅴ were significantly decreased in ulcer bleeding patients with mild and moderate anemia,and the levels of factorsⅦandⅩ were also significantly decreased in patients with mild,moderate and severe anemia.Meanwhile,the activity levels of factor Ⅷ were significantly increased in all four groups of ulcer bleeding patients with different degrees of anemia,and the activity levels of factor Ⅸ were also significantly increased in patients with no,mild and moderate anemia.Conclusions：The increased activity levels of coagulation factorsⅧ andⅨ play a crucial role in maintaining the normal level of body coagulation function in peptic ulcer bleeding.Blood coagulation preparations can facilitate blood coagulation and hemostasis,and thus help treat peptic ulcer bleeding.