凝血因子Ⅴ在重型肝炎患者中的检测及其临床意义

Detection of coagulation factor Ⅴ in patients with severe hepatitis and its clinical significance

目的 了解凝血因子Ⅴ (Ⅴ因子 )在重型肝炎预后因素中的作用及其在临床诊断标准中的意义。方法 通过比浊法对 5 8例重型肝炎患者进行了 12 9例次Ⅴ因子活性检测 ,并与同期凝血酶原活动度 (PTA)水平进行对比研究 ;以SPSS及SDAS软件对检测结果进行分析。结果 发生重型肝炎时Ⅴ因子和PTA水平分别为 15 3%± 9 7%及 2 3 5 %± 10 0 % ,随着病情的加重Ⅴ因子或PTA水平逐渐降低 ,病死率均逐渐升高 ,差异有非常显著意义 (P =0 0 0 0 ) ;死亡者Ⅴ因子及PTA水平逐步迅速降低 ,而存活者则逐渐升高。在病情加重或恢复时 ,PTA较Ⅴ因子先下降或先上升 ;在 14例 (2 4 14 % )出现肝性脑病的患者中 ,10例 (92 86 % )在病程终末期出现 ,远晚于Ⅴ因子水平下降的时间 ;通过分析可知 ,Ⅴ因子水平与PTA水平高度相关 (相关系数 0 812 ) ,临床测定值基本一致。结论 Ⅴ因子水平可作为重型肝炎预后的一个重要预后因素 ,较PTA水平更为特异。因此 ,同时测定PTA及Ⅴ因子水平 ,可以更早地、更准确地诊断重型肝炎 ;

Objective To investigate the prognostic significance and role of coagulation factor Ⅴ (CFⅤ) levels in clinical diagnostic criteria for severe hepatitis Methods The CFⅤ level and prothrombin activity (PTA) were tested by turbidimetry for 129 times in 58 patients with severe hepatitis Comparative studies and clinical significance of CFⅤ and PTA were analyzed by SPSS and SDAS softwares Results ① The levels of CFⅤ and PTA were 15 3%±9 7% and 23 5%±10 0%, respectively, at the onset of severe hepatitis. ② The mortality of severe hepatitis gradually increased with the gradual decrease of CFⅤ or PTA during the most severe stage of the illness ( P =0 000). ③ The levels of CFⅤ and PTA decreased continually and rapidly in patients who died but gradually increased in survivors The decrease or increase of PTA preceded that of CFⅤ on the exacerbation or convalescent stage. ④ Hepatic encephalopathy occurred in 14 cases (24 14%) In 10 cases, it occurred in the terminal stage of the illness, far later than the time of the decrease of CFV. ⑤ The level of CFⅤ was closely related to PTA (the correlation coefficient was 0 812), the level of CFⅤ was almost consistent with that of PTA Conclusion ① The level of CFⅤ is an important prognostic indicator in severe hepatitis and is more specific than PTA ② Simultaneous determination of CFⅤ and PTA may be helpful in earlier and more accurate diagnosis of severe hepatitis ③ Possible use of CFⅤ as one of the criteria for liver transplantation in patients with severe hepatitis should be studied