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

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≥100×10^9/L;B组(41例)血小板计数(50~99)×10^9/L;C组(34例)血小板计数(30~49)×10^9/L(34例);D组(31例)血小板计数≤29×10^9/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≥100×10^9/L的ACLF患者相比,血小板计数<100×10^9/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。

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

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≥100×10^9/L),group B(41 cases with the platelet numbers between50-99]×10^9/L),group C(34 cases with the platelet numbers between30-49]×10^9/L)and group D(31 cases with the platelet numbers≤29×10^9/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≥100×10^9/L,prothrombin time activity(PTA)were significantly lower,and international normalized ratio(INR)were significantly higher in patients with platelet number<100×10^9/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),αangle,maximal amplitude(MA)and coagulation index(CI)between group A and D(P<0.05),significant differences in values of k,αangle,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.