关键词: 血栓弹力图参数, 乙型肝炎肝硬化, 消化道出血

Abstract: Objective To explore the significance of thromboelastography parameters (TEG) in evaluating hepatitis B-related cirrhosis complicated with gastrointestinal bleeding.Methods Forty patients with hepatitis B-related cirrhosis who were treated in our hospital from May 2018 to May 2019 were enrolled as the research objects. Twenty healthy people who underwent physical examination during the same period of time were included as the control.group. According to whether the cirrhotic patients were complicated with gastrointestinal bleeding, the patients were divided into a bleeding group (n=20) and a non-bleeding group (n=20). The conventional coagulation function indexes and TEG test results were compared between the bleeding group, the non-bleeding group and the control group. Receiver operating characteristic curve (ROC) was drawn to analyze the value of TEG test results and conventional coagulation test in evaluating hepatitis B-related cirrhosis complicated with gastrointestinal bleeding.Results The platelet count (PLT) and fibrinogen (FIB) levels in the bleeding and non-bleeding groups of patients with hepatitis B-related cirrhosis were (67.1±33.2)×10⁹/L and (1.4±0.4)g/L, respectively; The non-bleeding group was (84.2±29.4)×109/L and (1.9±0.5)g/L], respectively, which were significantly lower than those in the control group [(190.6±47.3)×10⁹/L, (2.9±0.5)g/L, respectively, P<0.05]. While the levels of prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (APTT) in the bleeding group were [(15.3±3.4)s, (1.3±0.3), and (38.1±5.0)s, respectively; which were significantly longer than those of (15.4±3.5)s, (1.3±0.2), and (36.4±5.2)s in the non-bleeding group, and those of (10.4±0.8)s, (0.9±0.1), and (26.4±3.1)s in the control group respectively ( P<0.05]; The PLT and FIB levels in the bleeding group were [(67.1±33.2)×10⁹/L and (1.4±0.4)g/L, respectively, which were significantly lower than those of (84.2±29.4)×10⁹/L and (1.9±0.5)g/L in the non-bleeding group [P<0.05]; The blood clot formation time (K) in the bleeding group and the non-bleeding group of patients with hepatitis B cirrhosis were (3.3±0.5)min and (3.4±0.5)min, respectively, which were significantly higher than that of (2.2±1.4) min in the control group [P<0.05]. The coagulation angle (α) and maximum oscillation radiation (MA) levels were [(45.4±5.7) deg and (40.7±5.2) mm in the bleeding group; (51.3±5.1) deg and (48.4±6.0) mm] in the non-bleeding group, which were significantly lower than those of (60.3±6.7) deg and (58.6±7.3)mm in the control group, P<0.05], respectively; The K values of the treatment group of cirrhotic patients with bleeding were (7.4±3.0) min, which was significantly greater than that of (3.0±1.0) min in the non-treatment group (P<0.05), and the α angle and MA values in the treatment group were (46.2±5.8) deg and (32.8±8.0) mm respectively, which were significantly smaller than those of (58.4±7.3) deg and (42.3±6.8) mm in the non-treatment group (P<0.05). In the TEG test results, α angle, R, K and MA were the influencing factors of hemagglutinin in cirrhotic patients with bleeding (P<0.05).Conclusion For patients with hepatitis B related cirrhosis and gastrointestinal bleeding, thromboelastography may provide a more accurate and comprehensive assessment of coagulation status, among which the α angle parameter has the highest diagnostic performance.

Key words: Thromboelastography, Hepatitis B related cirrhosis, Gastrointestinal bleeding