肝硬化凝血状态的机制研究进展

Research progress on the mechanism of coagulation state in liver cirrhosis

肝硬化往往合并凝血功能障碍,主要表现为促凝因子与抗凝因子水平同时下降,其凝血状态可重新达到再平衡,然而,一旦脆弱的平衡状态被打破,肝硬化患者可出现低凝(出血)或高凝状态(血栓)。目前临床上常规凝血检查项目如凝血酶原时间(prothrombin time,PT)及活化部分凝血活酶时间(activated partial thromboplastin time,APTT)均不能反映肝硬化的凝血状态,近年来,一些学者将内源性凝血酶产生潜能(endogenous thrombin potential,ETP)比值、蛇毒诱导的凝固抑制试验(Protac-induced coagulation inhibition,PICI%)应用于肝硬化的凝血状态检测中,可有效评估其低凝或高凝状态。本文就肝硬化凝血状态机制及凝血功能检测项目在肝硬化中的最新研究进行概述,为肝硬化患者的诊治提供新理念。

Liver cirrhosis is often accompanied by coagulation dysfunction,which is mainly characterized by the parallel decrease of both procoagulant and anticoagulant factors,the coagulation state can be rebalanced.However,once the fragile balance is broken,patients with liver cirrhosis may have hypocoagulable state(hemorrhage) or hypercoagulable state(thrombosis).At present,routine coagulation tests such as prothrombin time(PT) and activated partial thromboplastin time(APTT) cannot reflect the coagulation state of liver cirrhosis.In recent years,some scholars have applied endogenous thrombin potential(ETP) ratio and Protac-induced coagulation inhibition(PICI%) to the detection of coagulation state of liver cirrhosis,which can effectively evaluate the hypocoagulable or hypercoagulable state.In this paper,we reviewed the latest research on the mechanism of coagulation state and coagulation function test in liver cirrhosis,providing new ideas for the diagnosis and treatment of patients with liver cirrhosis.