乙型肝炎肝硬化初级止血阶段相关因素的变化  

Changes of related factors in primary hemostasis stage of hepatitis B cirrhosis

作　　者：邓永东[1] 赵荣荣[1] 姚立琼[1] 蒋妮[1] 谭榜云[1] 邢乐康 DENG Yong dong;ZHAO Rong rong;YAO Li qiong;JIANG Ni;TAN Bang yun;XING Le-kang(The First Hospital of Lanzhou University,730000 Lanzhou,Gansu,China;The First Clinical Medical College of Lanzhou University,730000 Lanzhou,Gansu,China)

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

出　　处：《临床消化病杂志》2020年第3期137-140,共4页Chinese Journal of Clinical Gastroenterology

基　　金：甘肃省自然科学基金(No:17JR5RA270)。

摘　　要：[目的]了解乙肝肝硬化患者血小板、血管性血友病因子(vWF)和血管性血友病因子裂解蛋白酶(AD-AMTS13)水平的变化,明确其在初级止血阶段的临床意义.[方法]入选乙型肝炎肝硬化患者(肝硬化组)96例,根据Child-Pugh分级分为A级亚组(36例)、B级亚组(31例)、C级亚组(29例);20例健康人群作为正常对照组.对所有入选者进行血小板计数(PLT)、vWF抗原(vWF:Ag)和ADAMTS13抗原(ADAMTS13:Ag)检测.[结果]与正常对照组相比,肝硬化组的血小板计数有明显的下降,而vWF:Ag明显升高,ADAMTS13:Ag水平明显下降,2组间差异有统计学意义(P<0.01).随着Child-pugh分级A级到C级,vWF:Ag水平持续升高,PLT、AD-AMTS13:Ag水平明显下降,各级亚组间差异有统计学意义(P<0.01).相关分析发现PLT与vWF:Ag呈负相关(P<0.01),vWF:Ag与ADAMTS13:Ag呈负相关(P<0.01).[结论]乙肝肝硬化初级止血阶段vWF:Ag的增高和ADAMTS13:Ag减少补偿了有血小板数量的下降造成的止血障碍,达到了暂时的平衡,并不是既往认为的低凝状态.[Objective]To investigate the changes of platelet,von Willebrand factor(vWF)and AD-AMTS 13 levels in patients with hepatitis B cirrhosis and to clarify their clinical significance in primary hemostasis stage.[Methods]A total of 96 patients with hepatitis B cirrhosis were collected,according to Child-Pugh classification,they were divided into three groups:A-level group(36 cases),B-level group(31 cases)and C-level group(29 cases).Twenty healthy subjects were served as the normal control group.The platelet count(PLT),vWF antigen(vWF:Ag)and ADAMTS13:Ag were detected.[Results]The results showed that the platelet count in cirrhosis group decreased significantly,while vWF:Ag increased significantly and ADAMTS13:Ag decreased significantly(P<0.01)comparing with the normal control group,the differences between the two groups were statistically significant.With the Child-pugh grading A to C,vWF:Ag levels continued to rise,while PLT and ADAMTS13:Ag levels decreased significantly,and there was a significant difference among the groups(P<0.01).The correlation analysis showed that PLT was negatively correlated with vWF:Ag(P<0.01),and vWF:Ag was negatively correlated with ADAMTS13:Ag(P<0.01).[Conclusion]The increase of vWF:Ag and the decrease of ADAMTS 13:Ag in primary hemostasis stage of hepatitis B cirrhosis compensate for the hemostasis obstacle caused by the decrease of platelet count and reach a temporary balance,which was not the hypothermia state previously considered.

关 键 词：乙肝肝硬化 血小板 血管性血友病因子 血管性血友病因子裂解蛋白酶 

分 类 号：R575.2[医药卫生—消化系统]