El-Sayed Rokaya, El-Karaksy Hanaa, El-Raziky Mona, El-Hawary Manal, El Koofy Nehal, Helmy Heba, Fahmy Mona
Pediatrics Department Cairo University, Fayoum University, Al Fayoum, Egypt.
Blood Coagul Fibrinolysis. 2013 Mar;24(2):113-7. doi: 10.1097/MBC.0b013e3283569297.
We aimed at assessing the coagulation profile and detecting early evidence of fibrinolysis in pediatric patients with chronic liver disease. Seventy-six patients (40 boys) with a mean age of 9.8 ± 3.4 years suffering from chronic liver disease were enrolled in this study. They were followed up in the Pediatric Hepatology Unit, Cairo University Children's Hospital. Thirty healthy children were included as controls. Patients were classified etiologically into four groups: chronic viral hepatitis, autoimmune hepatitis, miscellaneous and cryptogenic groups. Investigations to detect coagulopathy were done for all patients and controls: prothrombin time (PT), activated partial thromboplastin time, fibrinogen, fibrinogen degradation products, and D-dimer and complete blood count. Liver functions were done for all patient groups. A significantly lower platelet count, prolonged prothrombin time, with prolonged aPTT time was detected in all patients compared with controls (P < 0.001). The fibrinogen level showed no significant difference between patients and controls. D-dimer level was significantly higher in the miscellaneous and cryptogenic groups when compared to other patient groups and control group (P < 0.001). Significantly higher D-dimer levels were detected in patients with liver cirrhosis of child class A and B compared with noncirrhotic and control groups (P < 0.001). D-dimer correlated positively with PT (r = 0.290, P = 0.003), and negatively with platelet count (r = -0.324, P = 0.001) and prothrombin concentration (r = -0.270, P = 0.018). Fibrinolytic activity, as evidenced by high D-dimer, was detected in pediatric patients with chronic liver disease particularly if cirrhotic.
我们旨在评估慢性肝病患儿的凝血情况，并检测纤维蛋白溶解的早期证据。本研究纳入了76例（40例男孩）平均年龄为9.8±3.4岁的慢性肝病患儿。他们在开罗大学儿童医院儿科肝病科接受随访。另外纳入30名健康儿童作为对照。患者按病因分为四组：慢性病毒性肝炎组、自身免疫性肝炎组、其他组和隐源性组。对所有患者和对照进行了检测凝血功能障碍的检查：凝血酶原时间（PT）、活化部分凝血活酶时间、纤维蛋白原、纤维蛋白原降解产物、D-二聚体以及全血细胞计数。对所有患者组均进行了肝功能检查。与对照组相比，所有患者的血小板计数显著降低，凝血酶原时间延长，活化部分凝血活酶时间也延长（P<0.001）。患者与对照组之间的纤维蛋白原水平无显著差异。与其他患者组和对照组相比，其他组和隐源性组的D-二聚体水平显著更高（P<0.001）。与非肝硬化组和对照组相比，A类和B类儿童肝硬化患者的D-二聚体水平显著更高（P<0.001）。D-二聚体与PT呈正相关（r=0.290，P=0.003），与血小板计数呈负相关（r=-0.324，P=0.001），与凝血酶原浓度呈负相关（r=-0.270，P=0.018）。在慢性肝病患儿中检测到了高D-二聚体所表明的纤维蛋白溶解活性，尤其是肝硬化患儿。
