合并感染华支睾吸虫对慢性乙肝患者凝血指标的影响

Effect of Clonorchis sinensis infection on the coagulation indexes of patients with chronic hepatitis B

目的分析乙型肝炎合并感染华支睾吸虫患者凝血相关指标的变化,为临床诊断和治疗以及预后监测提供参考价值。方法将收集的患者标本分为6个组,分别是健康组40例、慢性乙肝组47例、慢性乙肝肝硬化组47例、单纯感染华支睾吸虫组40例、慢性乙肝合并感染华支睾吸虫组30例及慢性乙肝肝硬化合并感染华支睾吸虫组27例,并检测凝血4项指标做统计分析,比较各组之间凝血指标的变化差异。结果与健康组相比,单纯华支睾吸虫组的纤维蛋白原(FIB)水平升高,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)指标延长,同时乙肝感染组及合并感染组的凝血酶时间(TT)、PT、APTT指标延长,FIB指标下降,差异有统计学意义(P<0.05);与慢性乙肝组相比,慢性乙肝肝硬化组与合并感染乙肝组的PT、APTT、TT指标延长,FIB指标水平下降,差异有统计学意义(P<0.05);同时与慢性乙肝肝硬化组和合并感染乙肝组相比,合并感染乙肝肝硬化组的PT、APTT、TT指标显著延长,FIB指标水平显著下降,差异有统计学意义(P<0.05)。结论合并感染华支睾吸虫会进一步加重乙肝患者的凝血功能障碍,影响疾病的治疗和预后,并且慢性乙肝患者随着疾病的进展至肝硬化会加重凝血功能发生障碍。因此,在治疗乙肝患者的同时要警惕是否有华支睾吸虫的感染,以进一步指导临床用药和监测预后。

ObjectiveTo analyze the changes of coagulation indicators in patients with hepatitis B complicated with Clonorchis sinensis(C.Sinensis),and provide reference value for diagnosis,drug using and prognosis monitoring.MethodsThe patient samples were collected from the Third Affiliated Hospital of Sun Yat-sen University from June 2018 to February 2022 and divided into six groups.They were 40 healthy patients,47 patients with simple chronic hepatitis B,47patients with post-hepatitis B liver cirrhosis,40 patients with C.Sinensis mono-infection,30 patients with chronic hepatitis B patients co-infected with C.Sinensis and 27 patients with post-hepatitis B liver cirrhosis patients coinfected with C.Sinensis.Four coagulation indexes,prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and fibrinogen(FIB),were detected and compared among the groups.ResultsCompared with the healthy group,C.Sinensis mono-infection group had higher level of FIB and delayed PT,APTT;chronic hepatitis B group and chronic hepatitis B patients co-infected with C.Sinensis group had delayed PT,APTT,TT and significant lower FIB,these differences were statistically significant(all P<0.05).Compared with simple chronic hepatitis B group,post-hepatitis B liver cirrhosis and chronic hepatitis B patients co-infected with C.Sinensis had significant delayed PT,APTT,TT and lower FIB(all P<0.05).Compared with the post-hepatitis B liver cirrhosis and chronic hepatitis B patients co-infected with C.Sinensis,post-hepatitis B liver cirrhosis patients coinfected with C.Sinensis group had significant delayed PT,APTT,TT and lower FIB(all P<0.05).Conclusions The coinfection of C.Sinensis will further aggravate the coagulation dysfunction of HBV patients,leading to poor treatment and prognosis.HBV patients will have worse coagulation function in the process to post-hepatitis B liver cirrhosis;Therefore,it is important to pay attention to C.Sinensis co-infection when treating HBV patients,so that further guidance on clinical use and monitoring of prognosis can be provided.