肝硬化患者凝血指标和血小板参数变化与出血倾向相关性研究

Correlation between changes of coagulation parameters and platelet parameters and bleeding tendency in patients with liver cirrhosis

目的探讨肝硬化患者凝血指标和血小板参数变化与出血倾向的相关性。方法将88例肝硬化患者及30例健康者纳入本研究,测定凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、凝血因子(FⅡ、FⅤ、FⅦ、FⅩ)凝血活性、血浆蛋白质C(PC)、血浆抗凝血酶原(AT-Ⅲ)、血小板计数(PLT)及血小板平均容积(MPV)等指标,采用单因素方差分析比较不同肝功能评级及不同出血倾向肝硬化患者资料差异;采用Pearson相关性分析比较变量间相关性。结果与对照组比较,肝硬化患者伴有PLT、FIB、PC、AT-Ⅲ、FⅡ、FⅤ、FⅦ、FⅩ等指标下降(P<0.05),而且这些指标水平随肝功能评级上升而下降(P<0.05);与对照组比较,肝硬化患者MPV、PT、APTT等指标升高(P<0.05),而且随肝功能评级上升而升高(P<0.05);有出血倾向的肝硬化患者PLT、FIB、FⅡ、FⅤ、FⅦ、FⅩ等指标显著低于无出血倾向肝硬化患者(P<0.05);MPV、PC、APTT、PC、AT-Ⅲ等指标显著高于无出血倾向肝硬化患者(P<0.05);PLT、FIB、FⅡ、FⅤ、FⅦ、FⅩ等指标与出血倾向呈负相关(P<0.05);MPV、PC、APTT、PC、AT-Ⅲ等指标与出血倾向呈正相关(P<0.05)。结论肝硬化患者凝血因子及血小板参数的改变可能为评估患者肝损伤严重程度、监测出血倾向的有效指标。

Objective To investigate the correlation between coagulation parameters and platelet parameters and hemorrhagic tendency in patients with liver cirrhosis.Methods Eighty-eight patients with liver cirrhosis and 30 healthy subjects were enrolled in the study.The prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),coagulation activity of coagulation factors(FⅡ,FⅤ,FⅦ,FⅩ),plasma protein C(PC),plasma anti-prothrombin(AT-Ⅲ),platelet count(PLT)and mean platelet volume(MPV)were determined.One-way analysis of variance was used to compare differences in data of liver cirrhosis patients with different grades of liver function and different bleeding tendencies.Pearson correlation analysis was used to perform the correlation between variables.Results The PLT,FIB,PC,AT-Ⅲ,FⅡ,FⅤ,FⅦand FⅩof patients with liver cirrhosis were lower than those of the control group(P<0.05),and the indexes decreased with the increase of the grade of liver function(P<0.05).The MPV,PT and APTT of patients with liver cirrhosis were higher than those of the control group(P<0.05),and the indexes increased with the increase of the grade of liver function(P<0.05).The PLT,FIB,FⅡ,FⅤ,FⅦand FⅩof patients with bleeding tendency were significantly lower than those in patients without(P<0.05),while MPV,PC,APTT,PC and AT-Ⅲwere significantly higher than those in patients without(P<0.05).PLT,FIB,FⅡ,FⅤ,FⅦ,FⅩwere negatively correlated with bleeding tendency(P<0.05),while MPV,PC,APTT,PC and AT-Ⅲwere positively correlated with bleeding tendency(P<0.05).Conclusion The changes of coagulation factors and platelet parameters in patients with liver cirrhosis may be effective indicators for assessing the severity of liver injury and monitoring bleeding tendency.