乙型肝炎肝硬化、酒精性肝硬化和自身免疫性肝硬化凝血相关参数比较

A Comparison of Coagulation Related Parameters Among Hepatitis B Cirrhosis,Alcoholic Cirrhosis and Autoimmune Cirrhosis

目的比较乙型肝炎肝硬化、酒精性肝硬化和自身免疫性肝硬化凝血参数和血小板计数的表达差异,探讨不同病因引起的肝硬化凝血指标差异的临床意义。方法回顾性分析2019年6月至2020年12月住院的肝硬化患者的临床资料,根据病因将肝硬化分为3组:乙肝肝硬化组、酒精性肝硬化组和自身免疫性肝硬化组。比较3组患者凝血指标和血小板计数的差异,并进一步比较分析Child-Pugh分级相同的情况下,3组患者的凝血相关指标表达水平差异。计量资料采用Kruskal-Wallis H检验,进一步两两比较采用Dunn-test进行多重比较。结果3组患者凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)和凝血酶时间(TT)和血小板计数(PLT)等指标,差异有统计学意义(P值均<0.05)。其中,乙肝肝硬化组PT、INR、APTT、TT均较自身免疫性肝硬化组表达水平明显增高(P值均<0.01),Fib、PLT水平明显降低(P值均<0.01)。乙肝肝硬化组较酒精性肝硬化组TT水平明显增高(P值<0.001),Fib和PLT水平明显降低(P值均<0.05)。酒精性肝硬化组PT、INR和APTT较自身免疫性肝硬化组明显延长(P值均<0.01)。Child-Pugh分级为A级患者中,乙肝肝硬化组较酒精性肝硬化和自身免疫性肝硬化组TT明显延长,Fib明显降低(P值均<0.05),乙肝肝硬化和酒精性肝硬化组较自身免疫性肝硬化组PT和INR明显延长(P值均<0.05)。Child-Pugh分级为B级患者中,乙肝肝硬化组较自身免疫性肝硬化组PT和INR明显延长(P值均<0.01)。乙肝肝硬化组较酒精性肝硬化组TT明显延长,Fib和PLT明显降低(P值均<0.05)。Child-Pugh分级为C级患者中,仅仅乙肝肝硬化组与自身免疫性肝硬化组TT差异具有统计学意义(P值<0.05),3组患者其他凝血指标差异均无统计学意义(P值均>0.05)。结论乙肝肝硬化、酒精性肝硬化和自身免疫性肝硬化患者凝血指标和血小板计数存在差异,联合凝血指标和血小板计数检测和病因综合判断肝硬化患者的病情和预后,为患者的后期治疗提供可靠依据。

Objective To compare the expression levels of coagulation parameters and platelet count in hepatitis B cirrhosis,alcoholic cirrhosis and autoimmune cirrhosis,and to explore the clinical significance of differences of coagulation parameters in cirrhosis patients caused by different mechanisms.Methods The clinical data of hospitalized patients with liver cirrhosis were analyzed retrospectively from June,2019 to December,2020.According to the etiology,liver cirrhosis patients were divided into the hepatitis B cirrhosis group,alcoholic cirrhosis group and autoimmune cirrhosis group.We then compared the expression levels of coagulation parameters and platelet count among three groups,and further analyzed the differences of expression levels of coagulation related parameters with the same Child-Pugh classification.Kruskal-Wallis H test was applied for continuous data,and Dunn-test was used for further comparison between the two groups.Results There were significant differences in prothrombin time(PT),international normalized ratio(INR),activated partial thromboplastin time(APTT),fibrinogen(Fib),thrombin time(TT)and platelet count(PLT)among three groups(all P<0.05).Among them,the expression levels of PT,INR,APTT and TT in the hepatitis B cirrhosis group were significantly higher than the autoimmune cirrhosis group(P<0.01),while levels of Fib and PLT were significantly lower(P<0.01).The expression levels of TT in the hepatitis B cirrhosis group was significantly higher than the alcoholic cirrhosis group(P<0.001),while levels of Fib and PLT were significantly lower(P<0.05).The expression levels of PT,INR,APTT in the alcoholic cirrhosis group were significantly higher than the autoimmune cirrhosis group(P<0.01).Among patients with Child-Pugh grade A,the levels of TT was significantly higher than the alcoholic cirrhosis group and autoimmune cirrhosis group,while the level of Fib was significantly lower(all P<0.05).Among patients with Child-Pugh grade B,the levels of PT and INR in the hepatitis B cirrhosis group were significantly higher than the autoimmune cirrhosis group(all P<0.01).The expression levels of TT in the hepatitis B cirrhosis group was significantly higher than the alcoholic cirrhosis group,while levels of Fib and PLT was significantly lower(all P<0.05).Among patients with Child-Pugh grade C,the differences of expression levels of TT between the hepatitis B cirrhosis group and autoimmune cirrhosis group were statistical significance(P<0.05),while there was no statistical significance in the expression differences of other coagulation related parameters(all P>0.05).Conclusion The expression levels of coagulation parameters and platelet count are different among hepatitis B cirrhosis,alcoholic cirrhosis and autoimmune cirrhosis patients.Comprehensive judgment of coagulation parameters,platelet count and etiology can contribute to the diagnosis and prognosis of different causes of cirrhosis patients,and provide a reliable basis for treatment of patients.