肝硬化患者凝血、纤溶指标及血小板变化与Child-Pugh分级的关系

目的]探讨肝硬化患者凝血、纤溶指标、血小板计数（BPC）的变化与Child-Pugh分级及上消化道出血的关系.方法]上海市公共卫生中心2009年2月至2011年3月90例肝硬化住院患者,按Child-Pugh分级A级15例、B级46例、C级29例,分为出血组（42例）、非出血组（48例）.均检测其凝血酶原时间（PT）、凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅹ及组织纤溶酶原激活物（t-PA）、D-二聚体（D-d）、血常规,比较各组患者的相关指标.结果]随Child-Pugh分级的增加患者PT显著延长,凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅹ、BPC逐渐降低,t-PA、D-d逐渐升高.PT、凝血因子Ⅱ、Ⅶ、BPC在Child-Pugh A、B、C组间两两比较差异有显著性;Child-Pugh B、C组凝血因子Ⅴ、Ⅹ显著高与Child-Pugh A组.出血组PT、BPC 与未出血组差异有显著性;Child B、C级肝硬化患者出血率显著高与A级,而C级病死率最高,且两两比较差异均有显著性.结论]肝硬化患者存在明显的凝血异常及纤溶亢进,且与临床病情严重程度密切相关; PT、BPC、Child-Pugh分级可作为上消化道出血的危险因素.

Relationship Between the Changes of Blood Coagulation, Fibrinolysis or Platelet and Child-Pugh Grade in Liver Cirrhosis Patients

Objective] To explore the relationship between the changes of blood coagulation, fibrinolysis or platelet and Child-Pugh grade or upper gastrointestinal bleeding in liver cirrhosis patients. Methods] Totally 90 hospitalized patients with liver cirrhosis in Shanghai public health clinical center from Feb. 2009 to March 2011 were divided into bleed- ing group（ n =42） and non-bleeding group（ n =48）. According to Child Pugh grade, there were 15 patients with class A, 46 patients with class B and 29 patients with class C. Prothrombin time（PT）, coagulation factors II, V, VI and X, tissue plasminogen activator （t-PA）, D-dimer（Dd） and blood routine parameters were measured. Results]With the increasing of Child-Pugh grade, PT was markedly prolonged, and coagulation factors II, V, VI, X and BPC were gradually decreased, t-PA and D-d were gradually increased. There were significant differences in PT, coagulation factors II and VI and BPC among Child-Pugh A, B and C groups. The levels of coagulation factors V and X in Child-Pugh B and C groups were higher than in those in Child-Pugh A group. There were significant differences in PT and BPC between bleeding group and non-bleeding group. The bleeding rate of in liver cirrhosis patients with Child-Pugh grade B and C was obviously higher than that of patients with Child Pugh grade A, but Child-Pugh C group had the highest mortality, and there were significant differences among groups. Conclusion] Liver cirrhosis patients have obvious coagulation disorder and hyperfibrinolysis, which are closely related to the severity of clinical pathogenetic condition. PT, BPC and Child-Pugh score are the risk factors of upper gastrointestinal bleeding.