凝血、纤溶和抗凝指标在慢性乙型肝炎病情进展中的变化规律

Change rule of blood coagulation,fibrinolysis and anti-coagulation indexes during the progress of chronic hepatitis B

目的探讨凝血、纤溶和抗凝指标在慢性乙型肝炎病情进展中的变化规律。方法收集2017年9月至2018年12月于该院确诊的乙型肝炎患者164例,根据病情分为慢性乙型肝炎组(66例)、肝硬化组(51例)、肝癌组(21例)、肝衰竭组(26例),同时选取50例健康体检者作为健康对照组。分别检测所有研究对象的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D二聚体(D-D)、纤维蛋白降解产物(FDP)和抗凝血酶-Ⅲ(AT-Ⅲ)水平。结果与健康对照组比较,慢性乙型肝炎组PT、APTT、TT、FIB差异均无统计学意义(P>0.05)。与健康对照组、慢性乙型肝炎组比较,肝硬化组、肝衰竭组PT、APTT及TT水平升高,而FIB水平显著下降(P<0.05),肝癌组PT、APTT、FIB均显著升高(P<0.05)。除肝癌组外,D-D及FDP水平随着病情的进展逐渐升高(P<0.05),AT-Ⅲ水平随着病情的进展逐渐下降(P<0.05)。结论随着慢性乙型肝炎病情的进展,凝血、纤溶和抗凝指标发生变化,有效监测这些指标对了解肝脏疾病进展、治疗和预后判断有着重要的临床意义。

Objective To investigate the change rule of blood coagulation,fibrinolysis and anti-coagulation indexes during the progress of chronic hepatitis B.Methods One hundred and sixty-four patients with definitely diagnosed hepatitis B in the hospital from September 2017 to December 2018 were collected and divided into the chronic hepatitis B group(n=66),liver cirrhosis group(n=51),hepatocellular carcinoma group(n=21)and hepatic failure group(n=26),and at the same time 50 persons undergoing the healthy physical examination were selected as the healthy control group.The thrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),D dimer(D-D),fibrin degradation products(FDP)and antithrombin-Ⅲ(AT-Ⅲ)were measured in all study subjects.Results The levels of PT,APTT,TT and FIB had no statistically significant differences between the healthy control group and chronic hepatitis B group(P>0.05).Compared with the healthy control group and chronic hepatitis B group,the levels of PT,APTT and TT in the liver cirrhosis group and hepatic failure group were increased,while the FIB level was significantly decreased(P<0.05),the levels of PT,APTT and FIB in the hepatocellular carcinoma group were significantly increased(P<0.05).Except for the hepatocellular carcinoma group,the levels of D-D and FDP were increased gradually with the progress of the disease condition(P<0.05),and the AT-Ⅲ level was gradually decreased with the progress of the disease condition(P<0.05).Conclusion With the development of chronic hepatitis B,the indexes of blood coagulation,fibrinolysis and anti-coagulation indexes have the changes.Effectively monitoring these indexes has an important clinical significance in understanding the development,treatment and prognosis of liver diseases.