Beijing Chaoyang Hospital Affiliate of Capital Medical University, Department of Gastroenterology, Beijing, China.
J Gastroenterol Hepatol. 2010 Jan;25(1):116-21. doi: 10.1111/j.1440-1746.2009.05921.x. Epub 2009 Aug 3.
To profile changes of coagulation, anticoagulation and fibrolytic factors associated with liver function failure and portal vein thrombosis (PVT) formation in chronic liver cirrhosis patients.
A total of 116 cirrhotic patients admitted to our hospital from June 2006 to October 2008 were included in our study. All patients were classified into two groups: PVT group (31 patients), composed of patients with PVT and a control group (85 patients), including patients without PVT. Platelet, prothrombin time (PT), activated partial prothrombin time (APTT) and fibrinogen were measured. Also, plasma samples from the patients were analyzed for the levels of antithrombin III (AT-III), protein C (PC), protein S (PS), D-dimer, tissue-type plasminogen activator as well as plasminogen activator inhibitor-1. Statistical analyses were carried out to evaluate the correlation of specific variations with the disease status.
In general, the higher Child-Pugh scores, indicating the aggravation of hepatic impairment of the patients, correlated well with the prolonged PT/APTT and increased D-dimer, as well as decreased platelet, fibrinogen, PC and AT-III levels in the serum. Furthermore, we found that the PC, PS and D-dimer levels in PVT patients were 2.32 +/- 0.72 mg/L, 17.14 +/- 3.62 mg/L and 0.99 +/- 0.36 mg/L, respectively, both representing a significant difference compared with those in the control group without PVT. Logistic regression model shows that the odds ratio value of one unit of increase of PC and D-dimer were 0.48 and 15.57.
Cirrhotic patients displayed dysfunctions in the coagulation, anti-coagulation and fibrolytic systems. The development of PVT in these patients may be independently associated with the decrease of PC, PS and D-dimer. Furthermore, decreasing PC and increasing D-dimer may be risk factors inducing PVT in cirrhotic patients.
分析与肝功能衰竭和门静脉血栓形成（PVT）相关的凝血、抗凝和纤溶因子在慢性肝硬化患者中的变化特征。
选取 2006 年 6 月至 2008 年 10 月我院收治的 116 例肝硬化患者，分为 PVT 组（31 例）和对照组（85 例）。检测血小板、凝血酶原时间（PT）、部分凝血活酶时间（APTT）和纤维蛋白原；分析血浆抗凝血酶Ⅲ（AT-III）、蛋白 C（PC）、蛋白 S（PS）、D-二聚体、组织型纤溶酶原激活物及纤溶酶原激活物抑制剂-1 水平。采用统计学方法分析各指标变化与疾病状态的相关性。
一般来说，Child-Pugh 评分越高，提示患者肝功能损害越严重，PT/APTT 延长、D-二聚体升高、血小板、纤维蛋白原、PC 和 AT-III 降低越明显。PVT 患者的 PC、PS 和 D-二聚体水平分别为（2.32±0.72）mg/L、（17.14±3.62）mg/L 和（0.99±0.36）mg/L，与无 PVT 的对照组比较差异均有统计学意义（P<0.05）。Logistic 回归模型显示，PC 和 D-二聚体每增加 1 个单位，发生 PVT 的比值比（OR）分别为 0.48 和 15.57。
肝硬化患者凝血、抗凝和纤溶系统功能异常，PVT 的发生可能与 PC、PS 和 D-二聚体降低有关，降低 PC 和升高 D-二聚体可能是肝硬化患者发生 PVT 的危险因素。
