血栓弹力图评价肝病不同阶段凝血功能的改变  

Evaluation of coagulation disorders in patients with different stages of liver disease by thrombelastogram

作　　者：黄晓英[1] 韩旭东[1] 王芳[1] 李名[1] 王美兰[1] 章幼奕[1] 

机构地区：[1]南通大学附属南通第三医院ICU,江苏南通226006

出　　处：《胃肠病学和肝病学杂志》2010年第6期537-539,共3页Chinese Journal of Gastroenterology and Hepatology

基　　金：南通市科委课题(S2007016)

摘　　要：目的用血栓弹力图(TEG)评价肝病不同阶段凝血功能的改变,探讨其临床意义。方法选择118例确诊为慢性乙型肝炎肝硬化患者,另选择无肝胆疾患、无血液系统疾病、未使用干扰凝血的药物,肝功能正常30例作为正常对照,所有患者均在入院时抽取静脉血4mL,其中2mL送检验科用于行常规凝血试验包括Plt计数、PT-INR、APTT等,2mL用于进行TEG检测。结果随着肝功能的恶化(CTP积分的增加),TEG检测参数中R时间和K时间呈延长趋势,而a角及MA有所缩短,呈下降趋势;反映血凝块强度的G值也随肝硬化程度的加重逐渐下降;与CTPB级相比,CTPC级患者低凝较为明显,反应纤溶的指标LY30组间比较无显著性差异。结论 TEG可提供凝血纤溶功能较为全面的信息,可全面反映肝硬化患者凝血紊乱状况,准确反映体内凝血功能失衡,TEG参数的异常幅度与肝硬化程度也密切相关,可间接反映肝硬化患者病情严重程度。Objective To appraise coagulation disorders in different stages of liver disease by thrombelastogram（TEG）,and to explore the clinical value of TEG.Methods One hundred and eighteen patients with established chronic HBV cirrhosis by chronic hepatitis B and 30 patients with normal liver function not receiving drugs interfered with blood clotting,without blood abnormalities and hepatobiliary disorders were enrolled.All patients were sampled 4 mL venous blood at admission,2 mL blood was assessed using a computerised TEG as recommended by the manufacturer,the other 2 mL were tested by routine methods to obtain conventional parameter such as Plt,APTT,PT-INR.Results With aggravation of liver function（with Child-Pugh score elevating）,the time of TEG R and K prolonged（P0.05）,a angle,MA and G decreased（P0.05）.Compared with CTP grade B,hypocoagulable state was more obvious in CTP grade C.There was no significant difference in LY30 in each group.Conclusion TEG is suitable for overall assessing coagulation disorder in cirrhosis patients.TEG can accurately respond coagulation dysfunction.The abnormality extent of TEG parameters is correlated with severity of cirrhosis.Severity of cirrhosis can be indirectly estimated according to the TEG.

关 键 词：血栓弹力图 肝病 凝血功能障碍 

分 类 号：R575[医药卫生—消化系统]