肝硬化及其并发症患者之凝血功能变化

目的 探讨肝硬化及其并发症患者之凝血功能变化。方法 109例肝硬化患者及其健康家属清晨空腹抽静脉血测定PT、PTA、PLT、A。结果 肝硬化组PT值明显延长,PLT、A值明显下降(P<0.001),且随肝功能分级愈差,PT值愈延长,PTA值下降愈明显(P<0.01～0.001),PLT值下降亦愈明显。脾切除者与未切除者比较,PLT值显著上升(P<0.001),PT、PTA值亦有所改善(P<0.05)。有腹水者与无腹水者比较,PT值明显延长(P<0.01),PTA、PLT值下降(P<0.05)。并发感染、肝性脑病者与无感染、无肝性脑病者比较,PT值明显延长(P<0.05～0.01),PTA值下降(P<0.05),PLT值无明显改变(P>0.05)。而并发原发性肝癌、消化道出血者与无原发性肝癌、无消化道出血者比较,PT、PTA、PLT值无明显改变(P>0.05)。结论 肝硬化患者存在不同程度的凝血功能障碍,且肝功能分级愈差,凝血功能障碍愈明显。肝硬化有腹水、并发感染、肝性脑病者,凝血功能障碍更严重。并发原发性肝癌、消化道出血者与无原发性肝癌、无消化道出血者比较,凝血功能无明显差异。而脾切除术不仅可改善脾亢,凝血功能亦有改善。

Changes of blood coagulation function of the patients with liver cirrohosis and its complications

Objective To investigate the change of the blood coagulation function of the patients with liver cirrhosis and its complication. Methods PT, PTA , PLT, A of 109 patients with liver cirrhosis and their healthy family members were assayed. Results The PT of patients with liver cirrhosis is higher obviously and the PLT, A is decrease obviously ( P < 0.001) . The poorer the liver function was, the higher the PT was, the lower the PTA, PLT was( P < 0.01 - 0.001) . The PLT of patients with splenectomy was higher obviously than that of patients without splenectomy( P < 0,01 ) . PT, PLT improved to some extent ( P < 0.05) . PT of patients with ascites was higher obviously than that of patients without ascites (P < 0.01) and PTA, PLT was lower( P < 0.05) . The PT of patients with infection or hepatic brain disease was higher obviously than that of patients without infection or hepatic brain disease( P < 0.05 - 0.01) and the PTA was lower( P < 0.05 ) , PLT had no obvious difference( P > 0.05) .PT,PTA,PLT of the patients with primary liver carcinoma or digestive tract hemorrhage had no obvious difference compared with that of patients without primary liver carcimoma or digestive tract hemorrhage ( P > 0.05 ) . Conclusion The patients with liver cirrhosis have blood coagulation function disorder to some extent. The poorer the liver function is, the more obvious the disorder is. The disorder is more severe in patients complicating ascites, infection or hepatic brain disease. The disorder is not obvious between the patients with or without primary liver carcinoma or digestive tract hemorrhage. Splenectomy can improve not only the hypersplenia but also the blood coagulation function.