终末期肝病凝血功能障碍的基础与临床表现研究进展

Advances in basic and clinical manifestations of coagulopathy in end-stage liver diseases

肝是人体最重要的生物合成器官,止血过程中的大部分促凝和抗凝因子由肝合成,同时还参与了许多止血和纤溶组分的清除过程。各种原因导致的终末期肝病都使得患者的肝合成能力显著下降,血浆中相应的凝血分子显著减少;而肝炎症和全身系统性炎症导致内皮细胞的慢性活化,使内皮细胞分泌的凝血组分明显增加。这种双向的变化使得终末期肝病所处的凝血状态变得异常复杂,其导致的最终结果也变得难以预测。多种常用凝血功能检测指标,如凝血酶原时间和凝血活酶时间等对于判断终末期肝病的凝血异常都显得作用微弱。深入了解终末期肝病凝血变化的特点和规律,结合更全面的检测手段,才能更有效的预防和治疗凝血并发症。文章从终末期肝病的凝血功能变化的特点、相关检测手段、治疗和预防等方面进行阐述。

The liver plays a central role in hemostasis as the site of synthesis of most procoagulant and anticoagulant factors, and the clearance of many hemostatic and fibrinolytic components. On one hand,the decreased synthetic capacity of the liver due to end-stage liver diseases(ESLD)results in decreased hepatocyte-derived hemostatic proteins in plasma. On the other hand,intrahepatic and systemic inflammation in liver diseases results in chronic endothelial cell activation with additional consumption of platelets and hemostatic proteins. This two-way change makes the clotting state of end-stage liver disease extremely complicated and unpredictable. The common laboratory tests,such as prothrombin time(PT)and activated partial thromboplastin time(aPTT),cannot precisely reflect the change of hemostasis in vivo in ESLD. Thus,in-depth understanding this disorder with more comprehensive tests,can more effectively promote the progress of diagnosis and treatment of coagulopathy in ESLD. This article reviews the characteristics of changes in coagulation function,related detection methods,treatment and prevention in ESLD.