凝血指标和血小板参数在肝病进展中的变化规律

目的包括血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)和血小板容积(PCT),探讨常见凝血指标和血小板参数在慢性病毒性肝炎、肝硬化及肝衰竭患者中的变化规律。方法选取2015年1月至2016年6月于该院治疗的肝病患者共120例,分为慢性病毒性肝炎组(46例)、肝硬化组(Child-Pugh A、B、C级)(44例)、肝衰竭组(30例)及同期健康体检者30例为健康对照组。检测所有受试者的凝血指标包括凝血酶原时间(PT)、凝血酶原活动度(PTA)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fg)、D-二聚体(D-D),以及血小板参数(PLT、MPV、PDW、PCT)。结果除TT、Fg和D-D在健康对照组与慢性病毒性肝炎组差异无统计学意义(P0.05),慢性病毒性肝炎组、肝硬化组(Child-Pugh A、B、C级)和肝衰竭组的PT、APTT和TT逐渐延长,PTA和Fg下降,D-D值增加,组间两两比较差异具有统计学意义(P0.05)。慢性病毒性肝炎组、肝硬化组(Child-Pugh A、B、C级)和肝衰竭组的PLT值逐渐下降,而MPV、PDW值逐渐增高,差异有统计学意义(P0.05),肝硬化组和肝衰竭组的PCT值低于慢性病毒性肝炎组(P0.05)。结论凝血指标和血小板参数在慢性肝病进展的不同时期发生规律性改变,为临床诊治及预后判断提供一定的参考。

Change rule of coagulation indicators and platelet parameters in progression of liver diseases

Objective To investigate the change rule of common coagulation indicators and platelet parameters in the patients with chronic viral hepatitis,liver cirrhosis and liver failure.Methods One hundrend and twenty patients with liver diseases in our hospital from January 2015 to June 2016 were selected and divided into chronic viral hepatitis group (46 cases),liver cirrhosis group (Child-Pugh class A,B,C,44 cases) and liver failure group (30 cases).Contemporaneous 30 persons undergoing healthy physical examination served as the healthy control group.The coagulation indicators (PT,PTA,APTT,TT, Fg,D-D) and platelet parameters (PLT,MPV,PDW, PCT) were detected in all subjects.Results Except TT,Fg and D-D had no statistical difference between the healthy control group and chronic viral hepatitis group (P>0.05),PT,APTT and TT in the chronic viral hepatitis group,liver cirrhosis group (Child-Pugh class A,B,C) and liver failure group were gradually extended,PTA and Fg were decreased and D-D value was increased,the difference in pairwise comparison was statistically significant (P<0.05).The PLT value in the chronic viral hepatitis group,liver cirrhosis group (Child-Pugh class A,B,C) and liver failure group was decreased gradually,while the MPV and PDW values were gradually increased,showing significantlystatistically significant difference (P<0.05),the PCT value in the liver cirrhosis group and liver failure group was lower than that in the chronic viral hepatitis group(P<0.05).Conclusion The regularity change of coagulation indicators and platelet parameters occurs in different periods of chronic liver disease progression,which provides some reference for clinical diagnosis,treatment and prognosis judgment.