肝硬化门静脉血栓形成患者凝血和纤溶系统变化的临床研究

目的研究肝硬化门静脉血栓形成（PVT）患者凝血和纤溶系统的变化。方法肝炎后肝硬化患者共87例，26例合并PVT作为血栓组，余61例作为对照组。对两组血小板（Pt）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fib）、D-二聚体（D-dimer）、组织纤溶酶原激活物（t-PA）和纤溶酶原激活物抑制剂-1（PAI-1）进行检测，对比两组各项指标的差异。结果血栓组患者D—dimer为（0．97±0．53）mg／L，显著高于对照组的（0．61±0．40）mg／L，两组比较差异有统计学意义（P=0．001）。血栓组与对照组的Pt、PT、APTT、Fib、t-PA和PAI-1检测结果差异无统计学意义。PT和APTT随肝功能恶化而延长，Fib随肝功能恶化而减少，Child-Push分级间比较差异有统计学意义。Pt随肝功能恶化而减少，t—PA和PAI-1随肝功能恶化而升高，但Child-Prtgh分级间比较差异无统计学意义。结论肝硬化患者凝血和纤溶系统存在明显异常。肝硬化PVT患者与无PVT患者相比D-dimer明显升高。肝硬化患者应常规检测D-dimer，如异常升高则提示患者可能合并PVT。

A study of coagulation and fibrinolytic system changes in liver cirrhosis patients with and without portal vein thrombosis

Objective To investigate the coagulation and fibrinolytic system changes in liver cirrhosis （LC） patients with and without portal vein thrombosis （PVT）. Method Twenty-six cases of LC with PVT （PVT group） and 61 cases of LC without PVT （control group） were chosen. Platelet（Pt）, prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrin （Fib）, D-dimer, tissue plasminogen activator （t-PA） and plasminogen activator inhibitor- 1 （PAI- 1 ） were determined. SPSS 11.5 software was used for statistic analysis. Results In PVT group, the average level of D-dimer was （0.97 ± 0.53 ） mg/L, significantly higher than that in control group （0.61 ± 0.40） mg/L. No significant difference was found between the two groups in Pt, PT, APTT, Fib, t-PA and PAI-1. PT and APTT were progressively prolonged from Child-Pugh grade A to B and then to C. Fib was progressively decreased from Child-Pugh grade A to B and then to C. Decreased Pt and increased t-PA, PAl-1 were found in LC patients, but had no significant difference. Conclusions The changes determined of coagulation and fibrinolytic system in patients with LC are abnormal. The average level of D-dimer is higher in LC patients with PVT than that in LC patients without PVT. D-dimer may be a helpful tool to rule out the presence of an underlying PVT in LC patients.