本文關鍵詞： 晚期血吸蟲病 乙型肝炎 肝硬化 凝血功能 血小板　出處：《中國血吸蟲病防治雜志》2017年01期 　論文類型：期刊論文

【摘要】：目的比較、分析晚期血吸蟲病肝硬化和乙型肝炎肝硬化患者凝血功能相關參數在不同肝功能分級下的差異,為臨床病情及預后的判斷提供進一步的指導依據。方法選擇荊州市中心醫(yī)院2014年1月-2016年6月期間住院的晚期血吸蟲病肝硬化患者63例、乙型肝炎肝硬化患者80例分別作為血吸蟲肝硬化組和乙肝肝硬化組;選擇同期因胃病住院并排除患其他可能影響凝血功能疾病的患者96例作為對照組,檢測并比較3組凝血相關參數值,以及不同Child-Pugh分級下晚期血吸蟲病肝硬化和乙型肝炎肝硬化患者相關參數值。結果 3組凝血酶原時間(PT)、國際標準化比率(INR)、纖維蛋白原(Fib)、凝血酶時間(TT)、活化部分凝血活酶時間(APTT)、血小板(PLT)水平差異均有統計學意義(F=84.512、81.672、37.612、104.475、52.497、102.233,P均0.05)。兩兩比較顯示,血吸蟲病和乙肝肝硬化患者的PT、INR、TT、APTT均較對照組明顯延長,PLT均明顯減少,差異均有統計學意義(P均0.05)。與血吸蟲病肝硬化組相比,乙肝肝硬化患者PT、INR、TT、APTT時間均明顯延長,Fib及PLT明顯下降,差異均有統計學意義(P均0.05)。肝功能分級為Child-Pugh A級時,乙肝肝硬化患者PLT減少程度較重;但當肝功能分級為Child-Pugh B、C級時,2組患者PLT計數差異無統計學意義(P均0.05)。各分級下,乙肝肝硬化組TT、APTT均較血吸蟲病肝硬化組延長,且Fib水平均明顯下降。而乙肝肝硬化組PT、INR值僅在肝功能為Child-Pugh A、B級時較血吸蟲病肝硬化組延長;在肝功能為C級時,兩組差異無統計學意義(P均0.05)。結論晚期血吸蟲病肝硬化患者和乙型肝炎肝硬化患者凝血功能損害程度存在差異。在肝功能受損程度較輕時,后者凝血功能下降更明顯;肝功能受損嚴重時,后者內源性凝血途徑的影響更為明顯,外源性凝血途徑的影響及PLT減少在兩類患者中差異不大。
[Abstract]:Objective to compare and analyze the difference of coagulation function related parameters in patients with advanced schistosomiasis cirrhosis and hepatitis B cirrhosis under different liver function grades. Methods 63 patients with advanced schistosomiasis cirrhosis hospitalized in Jingzhou Central Hospital from January 2014 to June 2016 were selected. Eighty patients with hepatitis B cirrhosis were treated as schistosomiasis cirrhosis group and hepatitis B cirrhosis group respectively. 96 patients who were hospitalized because of gastric diseases and excluded from other diseases that may affect coagulation function were selected as control group. The parameters related to coagulation were detected and compared among the three groups. Results in three groups of patients with advanced schistosomiasis cirrhosis and hepatitis B cirrhosis, the prothrombin time, the international standard ratio of Child-Pugh, fibrinogen, thrombin time and activated partial coagulation were obtained. There were significant differences in the levels of APTTT and PLT between the two groups (P < 0.05). There were significant differences in the levels of APTTT and PLT (84.512), 81.672 (37.612), 104.475 (52.497) and 102.233C (P < 0.05), respectively. Compared with the patients with schistosomiasis and cirrhosis of hepatitis B, the time of PLT and PLT in the patients with hepatitis B cirrhosis decreased significantly compared with those in the patients with schistosomiasis and liver cirrhosis, and the difference was statistically significant (P < 0.05), compared with the patients with schistosomiasis cirrhosis, the time of PTT in patients with hepatitis B cirrhosis was significantly longer than that in patients with cirrhosis of hepatitis B (P < 0.05). The difference was statistically significant (P < 0.05). When the liver function grade was Child-Pugh A, the decrease of PLT was more serious, but when the liver function grade was Child-Pugh C, there was no significant difference in PLT count between the two groups (P < 0.05). The Fib levels in liver cirrhosis group were longer than those in schistosomiasis cirrhosis group, and the Fib level in hepatitis B cirrhosis group was significantly lower than that in schistosomiasis cirrhosis group, and the Fib level in liver cirrhosis group was longer than that in schistosomiasis cirrhosis group only when the liver function was Child-Pugh Agna B grade, and when liver function was C grade, there was no significant difference between liver function group and liver cirrhosis group. There was no significant difference between the two groups (P < 0.05). Conclusion there is a difference in the degree of coagulation function damage between patients with advanced schistosomiasis cirrhosis and hepatitis B cirrhosis. When liver function was seriously damaged, the effect of endogenous coagulation pathway was more obvious. The effect of exogenous coagulation pathway and the decrease of PLT were not significantly different between the two groups of patients.
【作者單位】： 長江大學第二臨床醫(yī)學院荊州市中心醫(yī)院;長江大學醫(yī)學院;
【分類號】：R532.21;R512.62;R575.2

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