克罗恩病患者凝血功能异常及其与疾病活动性的关系

Correlation of Coagulation Disorders With Disease Activity in Patients With Crohn’s Disease

背景:克罗恩病(CD)患者存在高凝状态,较正常人更易发生血栓栓塞事件。目的:分析CD患者凝血功能异常与疾病活动性和疾病表型之间的联系。方法:2015年1月-2017年12月宁波市第一医院108例初诊活动期CD患者纳入研究,55名健康体检者作为对照组。分析CD患者凝血指标和血小板(PLT)计数与CD活动指数(CDAI)、CD简化内镜评分(SES-CD)的相关性;按疾病活动性、疾病表型等进行分层分析,并比较个体化治疗前后各项指标的变化。结果:CD患者纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)、PLT计数显著高于对照者,并在轻、中、重度患者中逐渐升高(P <0. 05);凝血酶原活动度(PTA)显著低于对照者,并在轻、中、重度患者中逐渐降低(P <0. 05)。CDAI和SES-CD与FIB、APTT、PLT计数呈显著正相关(P <0. 05),与PTA呈显著负相关(P <0. 05)。蒙特利尔分型B3型CD患者的FIB、APTT、PLT计数显著高于B1型患者(P <0. 05),PTA显著低于B1型患者(P <0. 05)。生物制剂治疗后,CD患者上述指标均有不同程度的改善,以PTA、PLT计数为著。结论:CD患者存在凝血-纤溶异常,并与疾病活动性和穿透型表型相关。凝血指标PTA或可成为CD疾病活动性的预测因子。

Background: Patients with Crohn’s disease( CD) are in hypercoagulable state and are susceptible to thromboembolic events. Aims: To investigate the correlation of coagulation disorders with disease activity and phenotype of patients with CD. Methods: A cohort of 108 newly diagnosed active CD patients from Jan. 2015 to Dec. 2017 at the Ningbo First Hospital were enrolled and compared with 55 healthy controls for coagulation and fibrinolysis status. Correlations between the altered coagulation indicators,platelet counts and the CD activity index( CDAI),simple endoscopic score for CD( SES-CD) were analyzed. Furthermore,stratification analysis was performed according to the disease activity,Montreal classification,and time points before and after individualized treatment. Results: The fibrinogen( FIB),activated partial thromboplastin time( APTT) and platelet counts were significantly higher in CD patients than in controls( P < 0. 05),and were elevated from mild,moderate to severe CD( P < 0. 05),while the prothrombin activity( PTA) was significantly lower in CD patients and decreased with the disease severity( P < 0. 05). Pearson correlation coefficient analysis revealed positive correlations between CDAI,SES-CD and FIB,APTT,platelet counts( P < 0. 05),as well as negative correlations between CDAI,SES-CD and PTA( P < 0. 05). Stratification analysis for Montreal classification showed the FIB,APTT and platelet counts in patients with phenotype B3 were significantly higher than those with phenotype B1( P < 0. 05),whereas the PTA in phenotype B3 was significantly lower( P < 0. 05). After treatment with biological agents,all the abovementioned indicators improved with varied degrees,especially PTA and platelet counts. Conclusions: Abnormal activation of coagulation and fibrinolysis occurs in CD patients,and is correlated with disease activity and penetrating phenotype. PTA might be a promising predictor for disease activity of CD.