摘要
目的比较、分析晚期血吸虫病肝硬化和乙型肝炎肝硬化患者凝血功能相关参数在不同肝功能分级下的差异,为临床病情及预后的判断提供进一步的指导依据。方法选择荆州市中心医院2014年1月-2016年6月期间住院的晚期血吸虫病肝硬化患者63例、乙型肝炎肝硬化患者80例分别作为血吸虫肝硬化组和乙肝肝硬化组;选择同期因胃病住院并排除患其他可能影响凝血功能疾病的患者96例作为对照组,检测并比较3组凝血相关参数值,以及不同Child-Pugh分级下晚期血吸虫病肝硬化和乙型肝炎肝硬化患者相关参数值。结果 3组凝血酶原时间(PT)、国际标准化比率(INR)、纤维蛋白原(Fib)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、血小板(PLT)水平差异均有统计学意义(F=84.512、81.672、37.612、104.475、52.497、102.233,P均<0.05)。两两比较显示,血吸虫病和乙肝肝硬化患者的PT、INR、TT、APTT均较对照组明显延长,PLT均明显减少,差异均有统计学意义(P均<0.05)。与血吸虫病肝硬化组相比,乙肝肝硬化患者PT、INR、TT、APTT时间均明显延长,Fib及PLT明显下降,差异均有统计学意义(P均<0.05)。肝功能分级为Child-Pugh A级时,乙肝肝硬化患者PLT减少程度较重;但当肝功能分级为Child-Pugh B、C级时,2组患者PLT计数差异无统计学意义(P均>0.05)。各分级下,乙肝肝硬化组TT、APTT均较血吸虫病肝硬化组延长,且Fib水平均明显下降。而乙肝肝硬化组PT、INR值仅在肝功能为Child-Pugh A、B级时较血吸虫病肝硬化组延长;在肝功能为C级时,两组差异无统计学意义(P均>0.05)。结论晚期血吸虫病肝硬化患者和乙型肝炎肝硬化患者凝血功能损害程度存在差异。在肝功能受损程度较轻时,后者凝血功能下降更明显;肝功能受损严重时,后者内源性凝血途径的影响更为明显,外源性凝血途径的影响及PLT减少在两类患者中差异不大。
Objective To analyze the differences of coagulation parameters between patients with advanced schistosomiasis cirrhosis and hepatitis B cirrhosis under different degrees of liver function, so as to provide the evidence for further guidance of judging clinical condition and prognosis. Methods Sixty？three patients with advanced schistosomiasis cirrhosis and eighty patients with hepatitis B induced cirrhosis hospitalized in Jingzhou Central Hospital from January 2014 to June 2016 were served as an advanced schistosomiasis cirrhosis group and a hepatitis B cirrhosis group, respectively, and ninety？six gastropathy patients excluded from other diseases that might affect coagulation in the same period were served as a control group. The levels of PT, INR, Fib, TT, APTT, and PLT of the patients among the above 3 groups and the cirrhosis patients with different Child？Pugh classes were detected and compared. Results The differences of the levels of PT, INR, Fib, TT, APTT, and PLT among the 3 groups were statistically significant （F = 84.512, 81.672, 37.612, 104.475, 52.497, 102.233; all P 〈0.05）. The further analysis showed that PT, INR, TT, and APTT of both the advanced schistosomiasis cirrhosis and hepatitis B induced cirrhosis groups were longer than those of the control group, and the PLT levels of both the former 2 groups were lower than that of the control group （all P 〈 0.05）. Compared with the advanced schistosomiasis cirrhosis group, PT, INR, TT, and APTT of the hepatitis B induced cirrhosis group were longer, and the levels of Fib and PLT were lower （all P 〈 0.05）. Among those with the liver function of Grade A, the reduced degree of PLT in the patients with hepatitis B induced cirrhosis was more serious, while for those with the liver function of Grade B and C, the difference between the patients with advanced schistosomiasis cirrhosis and hepatitis B induced cirrhosis was not statistically significant （both P 〉 0.05）. Under all the grades of liver function, TT and APTT of the hepatitis B induced cirrhosis group was longer than those of the advanced schistosomiasis cirrhosis group, and the Fib level of the former was lower than that of the latter. Among those with the liver function of Grade A and B, PT and INR of the hepatitis B induced cirrhosis group were longer than those of the advanced schistosomiasis cirrhosis group; while for those with the liver function of Grade C, the difference between the two groups was not statistically significant（all P 〉 0.05）. Conclusions There exist differences of the damage degrees of coagulation function between the patients with advanced schistosomiasis cirrhosis and hepatitis B cirrhosis. When the damage degree of the liver function is lighter, the coagulation function in the patients with hepatitis B cirrhosis decreases more significantly; when the damage degree becomes more severe, APPT in the patients with hepatitis B cirrhosis extends more significantly, while the differences of PLT and PT between them are little.
出处
《中国血吸虫病防治杂志》
CAS
CSCD
北大核心
2017年第1期68-71,76,共5页
Chinese Journal of Schistosomiasis Control
关键词
晚期血吸虫病
乙型肝炎
肝硬化
凝血功能
血小板
Advanced schistosomiasis
Hepatitis B
Cirrhosis
Coagulation function
Platelet
