凝血指标在判断肝硬化患者病变严重程度中的价值探讨

The value of coagulation index in judging the severity of liver cirrhosis

目的分析常用的凝血指标在判断肝硬化患者病变严重程度中的参考价值。方法以155例肝炎患者作为研究对象和54例无肝炎患者为对照组,观察其凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)和纤维蛋白原(FIB)的变化情况,同时对肝硬化组进行不同Child-Pugh分级,进一步亚组分析其凝血功能的改变,并分析PT的异常程度和肝病预后的关系。结果对照组、急性肝炎组、肝硬化组和重症肝炎组患者的PT、APTT、TT显著增加,而FIB逐渐减少,各组间相比差异均有统计学意义(P<0.05)。对照组、Child-Pugh A级、B级、C级的PT、APTT、TT均显著增加(P<0.05),而FIB均显著减少(P<0.05);PT异常程度和肝病预后呈正相关(r=0.463,P<0.05)。结论PT、APTT、TT和FIB的改变可以敏感地反映肝硬化患者的肝脏病变程度,及早有效监测和分析肝硬化患者的凝血功能变化对评估患者的病情和预后有着重要的参考价值。

Objective To analyze the reference value of commonly used coagulation index in judging the severity of liver cirrhosis. Methods Thrombolytic enzyme time（ PTT）,activated partial thromboplastin time（ APTT）,thrombin time（ TT） and fibrinogen（ PT） were observed in 155 patients with hepatitis（ the observation group） and 54 patients without hepatitisthe control group,and the changes of coagulation function were analyzed by subgroups of different Child-Pugh grades in cirrhosis group,and the relationship between PT abnormalities and the prognosis of liver disease was analyzed. Results PT,APTT and TT significantly increased in the control group,acute hepatitis group,cirrhosis group and severe hepatitis group,while FIB decreased gradually,with the differences among the different groups statistically significant（ P〈0. 05）. The levels of PT,APTT and TT in Child-Pugh A,B and C increased significantly（ P〈0. 05）,but FIB decreased significantly（ P〈0. 05）. The abnormality of PT was positively correlated with the prognosis of liver disease（ r = 0. 463,P〈0. 05）. Conclusion The changes of PT,APTT,TT and FIB can be sensitive to the degree of liver disease in patients with liver cirrhosis. Early monitoring and analysis of the changes of coagulation function in patients with liver cirrhosis are of great reference value in assessing patients＇ condition and prognosis.