慢加急性肝衰竭血小板减少患者血栓弹力图及常规凝血指标的变化

肝脏 ›› 2020, Vol. 25 ›› Issue (1): 20-23.

慢加急性肝衰竭血小板减少患者血栓弹力图及常规凝血指标的变化

袁宏香, 张秋云, 娄金丽, 于艳华, 赵艳

100069 北京首都医科大学附属北京佑安医院临检中心(袁宏香、娄金丽、于艳华、赵艳);
首都医科大学中医药学院中医络病研究北京市重点实验室(张秋云)

收稿日期:2019-10-15 发布日期:2020-03-25
通讯作者: 袁宏香,Email:yangzi06982@163.com
基金资助:
北京市自然科学基金面上项目(7192024)

Changes of thromboelastograms and routine coagulation parameters in patients with acute-on-chronic liver failure and thrombocytopenia

YUAN Hong-xiang¹, ZHANG Qiu-yun², LOU Jin-li¹, YU Yan-hua¹, ZHAO Yan¹

1.Beijing You′an Hospital, Capital Medical University, Beijing 100069, China;
2.Traditional Chinese Medicine Academy of Capital Medicine University, Beijing Key Laboratory of Traditional Chinese Medicine Collateral Disease Research, Beijing 100069, China

Received:2019-10-15 Published:2020-03-25
Contact: YUAN Hong-xiang, Email: yangzi06982@163.com

摘要/Abstract

摘要： 目的探讨慢加急性肝衰竭(ACLF)血小板减少患者中血栓弹力图各项指标及常规凝血指标的变化。方法选择2017年11月至2018年11月在北京佑安医院住院诊断为慢加急性肝衰竭患者145例,按照血小板计数将患者分为4组:A组(39例)血小板计数≥100×10⁹/L;B组(41例)血小板计数(50~99)×10⁹/L;C组(34例)血小板计数(30~49)×10⁹/L(34例);D组(31例)血小板计数≤29×10⁹/L。检测4组患者血栓弹力图五项指标(R值、K值、Angle角、MA值、CI值)及常规凝血指标PT、APTT、PTA、INR,并进行组间比较。结果与血小板计数≥100×10⁹/L的ACLF患者相比,血小板计数<100×10⁹/L的患者PTA值明显降低,INR值明显升高,差异均有统计学意义(P<0.05)。A组患者PTA、INR值分别为31.80±7.02、2.43±0.61;B组患者PTA、INR值分别为27.44±10.15、2.79±0.92;C组患者PTA、INR值分别为27.85±9.33、2.69±0.72;D组患者PTA、INR值分别为25.25±6.50、3.05±1.46,B组、C组与A组相比差异无统计学意义(P>0.05),D组与A组相比差异有统计学意义(P<0.05);与A组相比,D组患者R值、k值、Angle角、MA值、CI值与A组相比差异有统计学意义(P<0.05);C组患者k值、Angle角、MA值、CI值与A组相比差异有统计学意义(P<0.05);B组患者仅CI值与A组相比差异有统计学意义(P<0.05)。结论 ACLF患者凝血功能易出现异常,血栓弹力图能够更好的评估患者的凝血功能及纤溶状态,对预测和治疗患者出凝血有重要意义。

关键词: 慢加急性肝衰竭, 血栓弹力图, 凝血项

Abstract: Objective To investigate the changes of coagulation function in patients with acute-on-chronic liver failure (ACLF) and thrombocytopenia. Methods One hundred and forty-five cases of patients with ACLF and thrombocytopenia were divided into 4 groups, including group A (39 cases with the platelet numbers ≥ 100×10⁹/L), group B (41 cases with the platelet numbers between [50-99]×10⁹/L), group C (34 cases with the platelet numbers between [30-49]×10⁹/L) and group D (31 cases with the platelet numbers ≤ 29×10⁹/L). The coagulation function was evaluated using thromboelastography (TEG) and routine coagulation tests, and compared among the groups. Results Compared with patients of ACLF with platelet number ≥ 100×10⁹/L, prothrombin time activity (PTA) were significantly lower, and international normalized ratio (INR) were significantly higher in patients with platelet number < 100×10⁹/L, the difference was statistically significant (P<0.05). The levels of PTA and INR were 31.80 ± 7.02 and 2.43 ± 0.61 in group A, 27.44 ± 10.15 and 2.79 ± 0.92 in group B, 27.85 ± 9.33 and 2.69 ± 0.72 in group C, 25.25 ± 6.50 and 3.05 ± 1.46 in group D, respectively. Compared with group A, group B and C had no significant difference in levels of prothrombin time and activated partial thromboplastin time, yet group D had significant difference. In the TEG, there were significant differences in the reaction time, speed of clot formation (k), α angle, maximal amplitude (MA) and coagulation index (CI) between group A and D (P<0.05), significant differences in values of k, α angle, MA and CI between group A and C (P<0.05), and significant differences in value of CI between group A and B (P<0.05). Conclusion The coagulation function of ACLF patients is prone to abnormality. The TEG can evaluate the coagulation function and fibrinolysis status of patients well, which is important for diagnosis and treatment of coagulation disorder in patients.

Key words: Acute-on-chronic liver failure, Thrombelastography, Routine coagulation tests

袁宏香, 张秋云, 娄金丽, 于艳华, 赵艳. 慢加急性肝衰竭血小板减少患者血栓弹力图及常规凝血指标的变化[J]. 肝脏, 2020, 25(1): 20-23.

YUAN Hong-xiang, ZHANG Qiu-yun, LOU Jin-li, YU Yan-hua, ZHAO Yan. Changes of thromboelastograms and routine coagulation parameters in patients with acute-on-chronic liver failure and thrombocytopenia[J]. Chinese Hepatolgy, 2020, 25(1): 20-23.

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