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目的探讨重症肝病患者凝血指标和血小板参数变化与病情的关系。方法分别应用SysmexCA-50半自动血凝仪和SysmexXS800i全自动五分类血细胞分析仪检测120例重症肝病患者和50例健康对照者及30例非重型肝炎组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白(Fbg)和血小板计数(PLT)、血小板压积(PCT)、血小板分布宽度(PDW)、血小板平均体积(MPV)。结果非重型肝炎组与健康对照组比较,只有PLT、PCT低于健康对照组(P<0.05),其他6项差异无统计学意义;急、慢性重型肝炎组、肝硬化组、肝癌组与健康对照组比较,PT、APTT、TT明显延长,与肝细胞的受损程度呈正相关,Fbg、PLT、PCT显著减少,与肝细胞的受损程度呈负相关,MPV增大。结论重症肝病患者血液处于明显低凝状态,具有出血倾向。对重症肝病患者进行有关治疗前联合检测凝血指标和血小板参数,有助于早期发现肝病患者的凝血机制障碍,对其及早预防继发性出血和抢救及预后治疗有重要的临床意义。
Objective To investigate the relationship between coagulation parameters and platelet parameters in patients with severe liver disease. Methods SysmexCA-50 semi-automatic blood coagulation analyzer and SysmexXS800i automatic five-class hematology analyzer were used to detect prothrombin time (PT), activated partial thromboplastin in 120 patients with severe liver disease, 50 healthy controls and 30 non-severe hepatitis patients respectively. APTT, TT, Fbg and PLT, PCT, PDW, and MPV. Results Compared with healthy control group, only PLT and PCT were lower in non-severe hepatitis group than those in healthy control group (P <0.05), but there was no significant difference in the other 6 groups. There was no significant difference between non-severe hepatitis group and healthy control group in acute and chronic severe hepatitis group, cirrhosis group, Compared with control group, PT, APTT and TT were significantly prolonged, which were positively correlated with the degree of damage of hepatocytes. Fbg, PLT and PCT were significantly decreased, and were negatively correlated with the degree of damage of hepatocytes and MPV. Conclusion The blood of patients with severe liver disease is in a state of obvious hypocoagulation with bleeding tendency. It is of great clinical significance to detect coagulation indexes and platelet parameters in patients with severe liver disease before the treatment to find out the clotting mechanism obstacle in the early stage of liver disease and prevent its early secondary bleeding and rescue and prognosis.