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乙型肝炎肝硬化患者促凝和抗凝血因子变化分析
Changes in procoagulant and anticoagulant factors in patients with hepatitis B cirrhosis
文章发布日期:2019年01月07日  来源:  作者:邓永东,彭雪彬,姚立琼,等  点击次数:159次  下载次数:19次

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【摘要】:目的 了解乙型肝炎肝硬化患者的促凝、抗凝血因子以及临床常规凝血指标的变化,明确其临床意义。方法 选取2017 年1月-2018年10月于兰州大学第一医院感染科门诊及住院的乙型肝炎肝硬化患者105例,根据Child -Pugh分级分为3组:A级组(n=42)、B级组(n=39)、C级组(n=24),对所有患者检测常用临床凝血指标如凝血酶原时间(PT)、活化部分凝血酶原时间(APTT),凝血因子(Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅺ),抗凝血因子抗凝血酶(AT)、蛋白C(PC)、游离蛋白S(FPS) 。计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验,相关性分析采用Spearman相关分析法。结果 不同Child-Pugh分级的乙型肝炎肝硬化患者PT、APTT差异均有统计学意义(F值分别为55.11、12.09,P值均<0.001),C级组均显著高于B级和A级组,B级组均显著高于A级组(P值均<0.05)。凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅺ活性在不同Child-Pugh分级的乙型肝炎肝硬化患者中差异均有统计学意义(F值分别为32.52、14.77、38.88、9.24,P值均<0.001),C级组均显著低于B级和A级组,B级组均显著低于A级组(P值均<0.05)。不同Child-Pugh分级的乙型肝炎肝硬化患者凝血因子Ⅷ活性差异有统计学意义(F=4.44,P<0.05),C级患者的凝血因子Ⅷ活性显著高于B级和A级,差异均有统计学意义(P值均<0.05),但A级与B级组间差异无统计学意义(P>0.05)。不同Child-Pugh分级的乙型肝炎肝硬化患者AT、PC、FPS活性组间比较差异均有统计学意义(F值分别为25.90、30.46、15.58,P值均<0.001),C级组均显著低于B级和A级组,B级组均显著低于A级组(P值均<0.05)。相关分析发现,Child-Pugh分级与凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅺ及抗凝血因子PC、FPS、AT均呈负相关(r值分别为-0.687、-0.460、-0.706、-0.426、-0.723、-0.646、-0.468,P值均<0.001),其中与凝血因子Ⅱ、Ⅶ、抗凝血因子PC的相关性较强。而凝血因子Ⅱ、Ⅶ与抗凝血因子PC均呈正相关(r值分别为0.851、0.745,P值均<0.001)。结论 乙型肝炎肝硬化患者促凝血因子减少的同时伴有抗凝血因子的减少,而两者的变化有明显的相关性,可能在体内重新形成一种不稳定的平衡,并不是常规认为的低凝状态。
【Abstract】:Objective To investigate the changes in procoagulant and anticoagulant factors and routine coagulation markers in patients with hepatitis B cirrhosis and their clinical significance. Methods A total of 105 patients with hepatitis B cirrhosis who were admitted to Department of Infectious Diseases in The First Hospital of Lanzhou University from January 2017 to October 2018 were enrolled, and according to the Child-Pugh class, these patients were divided into group A (42 patients with Child-Pugh class A cirrhosis), group B (39 patients with Child-Pugh class B cirrhosis), and group C (24 patients with Child-Pugh class C cirrhosis). Routine coagulation markers including prothrombin time (PT) and activated partial prothrombin time (APTT), blood coagulation factors (Ⅱ,Ⅴ, Ⅶ, Ⅷ, and Ⅺ), anti-thrombin (AT), protein C (PC), and free protein S (FPS) were measured for all patients. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups; a Spearman correlation analysis was also performed. Results There were significant differences in PT and APTT between the three groups (F=55.11 and 12.09, both P<0.001); group C had significantly higher PT and APTT than groups A and B, and group B had significantly higher PT and APTT than group A (all P<0.05). There were significant differences in the activities of blood coagulation factors Ⅱ, Ⅴ, Ⅶ, and XI between the three groups (F=32.52, 14.77, 38.88, and 9.24, all P<0.001); group C had significantly lower activities of these coagulation factors than groups B and A, and group B had significantly lower activities than group A (all P<0.05). There was a significant difference in the activity of blood coagulation factor Ⅷ between the three groups (F=4.44, P<0.05); group C had a significantly higher activity than groups A and B (P<0.05), while there was no significant difference between group A and group B (P>0.05). There were significant differences in the activities of AT, PC, and FPS between the three groups (F=25.90, 30.46, and 15.58, all P<0.001); group C had significantly lower activities than groups B and A, and group B had significantly lower activities than group A (all P<0.05). The correlation analysis showed that Child-Pugh class was negatively correlated with blood coagulation factors Ⅱ, Ⅴ, Ⅶ, and Ⅺ and anticoagulant factors PC, FPS, and AT (r=-0.687, -0.460, -0.706, -0.426, -0.723, -0.646, and -0.468, all P<0.001), and Child-Pugh class had the strongest correlation with blood coagulation factors Ⅱ and Ⅶ and the anticoagulant factor PC. Blood coagulation factors II and Ⅶ were positively correlated with the anticoagulant factor PC (r=0.851 and 0.745, both P<0.001). Conclusion Patients with hepatitis B cirrhosis have reductions in both procoagulant and anticoagulant factors, and there is a significant correlation between them. An unstable balance may form in the body, which is not considered a conventional hypocoagulable state.
【关键字】:肝炎, 乙型; 肝硬化; 血液凝固因子; 抗凝血酶类
【Key words】:hepatitis B; liver cirrhosis; blood coagulation factors; antithrombins
【引证本文】:DENG YD, PENG XB, YAO LQ, et al. Changes in procoagulant and anticoagulant factors in patients with hepatitis B cirrhosis[J]. J Clin Hepatol, 2019, 35(2): 345-348. (in Chinese)
邓永东,彭雪彬,姚立琼,等. 乙型肝炎肝硬化患者促凝和抗凝血因子变化分析[J]. 临床肝胆病杂志, 2019, 35(2): 345-348.

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