肝移植患者凝血和纤溶指标变化临床价值研究  

A Study on Clinical Value of the Functional Changes of Coagulation and Fibrinolysis in Patients Undergone Liver Transplantation.

作　　者：温春光[1] 罗绍凯[1] 李娟[1] 彭爱华[1] 刘敏[1] 刘莉莉[1] 何晓顺 

机构地区：[1]广东省中山大学附属第一医院血液科,510080 [2]广东省器官移植研究中心

出　　处：《医学研究通讯》2004年第9期12-14,共3页Bulletin of Medical Research

摘　　要：目的为了解肝移植患者移植前后凝血和纤溶功能的变化,及其在临床应用价值。方法随机观察肝移植患者41例,在移植前后及排斥后和冲击治疗后,均检测血浆凝血酶原时间(PT)、活性部分凝血活酶时间(AFTT)、凝血酶时间(TT)、凝血因子纤维蛋白原(FIB)、Ⅶ(FⅦ)、Ⅷ(FⅧ)和 D-二聚体(D-D)含量。结果①41例肝移植患者其中有排斥者16例(急性排斥12例、慢性排斥4例);②所有移植者在移植前 PT、AFTT 时间延长(分别为21.4±1.68,43.5±2.0s)和FIB 减少(282.2±19.3mg/dl)、FⅦ活性减少(77.1±5.4%);③移植后有排斥者血浆 FⅦ活性进一步减少(73.3±7.9%)、FⅧ活性减低(75.7±9.1%),而 D-D 含量则升高(5.5.±0.65mg/L);④冲击治疗无效者 FIB 明显减少(132.0±36.5mg/dl),而D-D 则进一步升高(8.32±0.99mg/dl);⑤移植后排斥死亡者 D-D 明显升高(7.98±1.19mg/dl)。结论本研究结果显示:①移植患者在移植前已有凝血指标 PT、APTT 延长,凝血因子 FIB、FⅦ减少,而 D-D 变化不大;②肝移植后有排斥者 FⅦ、FⅧ活性明显减低,而 D-D 含量则明显升高,提示 D-D 可作为肝移植后排斥反应的监测指标,而 FⅦ、FⅧ则有助于排斥反应的监测;③D-D 可作为监测排斥反应冲击治疗后有效与无效的指标;且还可作为预测预后的指标之一。Objective To investigate the functional change of coagulation and fibrinolysis in patients undergone liver transplantation and its clinical Value.Methods 41 liver transplantation cases randomly were obserrde the patients' levels of plasma PT,APTT,TT,coagulation factor FIB,Ⅶ,Ⅷ and D-dimer (D-D) on,before and after operation,and after rejection nd pulse therapy.Results 1 among 41 cases,16 cases with rejection 12 cases with acute rejection 4 cases with chronic rejection;2.The levels of PT,APTT postponed (21.4±1.6s,43.5± 2.0s),and the level of FIB and FⅦ activity decreased (282.2±19.3mg/dl,77.1±5.4%) in all 41 cases before transplantation;3.The level of FⅦ and FⅧ further decreased (73.3±7.9 %,75.7±9.1%),however the leveI of D-D increased (5.51±0.65mg/L) in patients undergone rejection;4.The levels of FIB much decreased (132.0±36.5mg/dl) and the level of D-D increased significantly (8.32±0.99mg/ L) in the group of ineffi cacy after pulse therapy;5.The level of D-D increase significantly in dead group after transplantation (7.98± 1.19mg/L) .Conclusion 1.The levels of PT,APTT postponed in patients before liver transpllantation,the levels of FIB and FⅦ decreases, however the level of D-D was near normal;2.The levels of FⅦ、FⅧ decreased significantly in patients undergone rejection,while D-D in- creased significantly.So the levels of D-D and FⅦ could be taken as markers for liver transplantation rejection;3.The level of D-D could be taken as a marker to monitor the effect of pulse therapy and judge the patients' prognosis.

关 键 词：D—D 肝移植 患者 升高 FIB 冲击治疗 排斥反应 活性 含量 延长 

分 类 号：R657.3[医药卫生—外科学] R446[医药卫生—临床医学]