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目的:探讨肝硬化患者凝血功能指标的变化情况,及其肝功能分级的关系,为临床病情及预后的判断提供进一步的指导依据。方法:选择我院2007年12月—2009年12月乙肝肝硬化患者50例作为研究对象,设立为肝硬化组,肝功能Child-Pugh分级:A级12例,B级25例,C级13例。选择同期入院的正常体检者30例为对照组,全部入选对象均清晨空腹抽取静脉血1.7mL,注入浓度为109mmol/L枸椽酸钠0.3mL抗凝,3 000r/min离心10min,分离血浆后应用日本sysmexCA7000全自动血凝分析仪检测凝血酶原时间、TT、部分活化凝血酶时间、纤维蛋白原(FIB)。结果:与正常对照组比较,肝硬化患者的凝血指标PT、APTT、TT均较高,而肝硬化组FIB较低,两组各项凝血指标分别比较,差异有统计学意义。A级APTT、TT、FIB均高于B级,PT低于B级,差异有统计学意义。B级APTT、TT、PT均低于C级,FIB高于C级,差异有统计学意义。其中PT、TT随着肝功能分级的增加呈逐渐上升趋势,而FIB随着肝功能分级的增加呈逐渐下降趋势。结论:肝硬化患者凝血和纤溶系统功能异常,且其凝血功能变化与肝功能分级关系密切,凝血四项检测对判断肝硬化的病情和预后具有重要的临床意义。
Objective: To investigate the changes of coagulation parameters in patients with liver cirrhosis and their relationship with the grading of liver function, and to provide further guidance for the judgment of clinical condition and prognosis. Methods: Fifty patients with hepatitis B cirrhosis from December 2007 to December 2009 in our hospital were enrolled in the study. Patients with cirrhosis and liver function were classified as Child-Pugh, with 12 cases of grade A, 25 cases of grade B and 13 cases of grade C example. Select the same period of hospitalization of 30 normal subjects as control group, all subjects were fasting venous blood 1.7mL, the concentration of 109mmol / L sodium citrate 0.3mL anticoagulant, 3000r / min centrifuged 10min, after the separation of plasma Application Japan sysmexCA7000 automatic hemagglutination analyzer prothrombin time, TT, partial activation of thrombin time, fibrinogen (FIB). Results: Compared with the normal control group, the coagulation indexes PT, APTT and TT in patients with cirrhosis were higher, while the FIB in cirrhosis group was lower. There were significant differences between the two groups in the coagulation indexes. Grade A APTT, TT, FIB were higher than the B level, PT lower than the B level, the difference was statistically significant. Grade B APTT, TT, PT were lower than C grade, FIB higher than C grade, the difference was statistically significant. Among them, PT and TT increased gradually with the increase of liver function, while FIB decreased gradually with the increase of liver function. Conclusion: The coagulation and fibrinolytic system of patients with liver cirrhosis are abnormal, and the change of coagulation function is closely related to the grading of liver function. The four tests of coagulation have important clinical significance in judging the condition and prognosis of cirrhosis.