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

作　　者：邓永东[1] 彭雪彬[1] 姚立琼[1] 李海[1] 谭榜云[1] 马超群 DENG Yongdong;PENG Xuebin;YAO Liqiong(The First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一医院,兰州730000 [2]兰州大学第一临床医学院,兰州730000

出　　处：《临床肝胆病杂志》2019年第2期345-348,共4页Journal of Clinical Hepatology

基　　金：甘肃省科技计划资目--甘肃省自然科学基金(17JR5RA270)

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�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,andⅪ),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 factorsⅡ,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 factorⅧbetween 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 th

关 键 词：肝炎 乙型 肝硬化 血液凝固因子 抗凝血酶类 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]