原发性肝癌TACE前后凝血指标的变化及临床意义

目的研究原发性肝癌介入治疗前后凝血指标的变化。方法采用全自动血凝分析仪检测65例肝癌患者介入治疗前后第1、3、5、15、30天的凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）含量变化。结果介入治疗后第1天，PT、APTT较介入治疗前升高，差异有统计学意义（P〈0．05）；介入治疗5d以后，PT较治疗前均表现为降低，差异有统计学意义（P〈0．05）；APTT介入治疗后15d较治疗前降低，差异有统计学意义（P〈0．05）；术后第3、5天FIB含量较治疗前升高，差异有统计学意义（P〈0．05），以后成渐进性下降趋势，术后30dFIB较治疗前降低，差异有统计学意义（P〈0．05）；对于Child分级各组PT结果显示只有ChildA级第5天以后，PT较治疗前表现为降低，差异有统计学意义（P〈0．05）。结论肝癌介入治疗前后应加强观察，尤其在介入治疗早期，及时进行相应的实验室检查，以期早期发现，及时处理，防止弥散性血管内凝血（DIC）的发生，尤其对于Child C级的患者更应该注意。

Changes of blood coagulation indicators in patients with primary liver cancer before and after TACE and its clinical significance

Objective To study the changes of blood coagulation indicators in patients with primary liver cancer before and after transcatheter arterial chemoembolization (TACE). Methods The changes of prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen (FIB) content were determined by automated coagulation analyzer in 65 patients with liver cancer before treatment and in the 1, 3, 5, 15 and 30 days after intervention treatment. Results In the first day of the intervention, the levels of PT and APTT were significantly higher than those before the treatment (P<0.05). The level of PT was significantly lower in the 5th day than that before the treatment (P<0.05), and the level of APTT was significantly lower in the 15th day than that before treatment. FIB content increased significantly after 3-day and 5-day treatment and FIB content had a down-ward tendency. After 30-day treatment, FIB content was significantly lower than that before treatment. According to the Child classification, the determination result showed that the level of PT was significantly lower in the 5th day than that before treatment only in Child A Group. There was statistical difference (P<0.05). Conclusions Before and after observation treatment, coagulation indicators of patients with primary liver cancer, especially the patients like Child A Group, should be determined, particularly in the early stage of treatment, in order to prevent diffuse intravascular coagulation (DIC).