Department of Anaesthesia, Royal Free London NHS Foundation Trust, London, UK.
Liver Int. 2013 Aug;33(7):961-74. doi: 10.1111/liv.12158. Epub 2013 May 3.
The prothrombin time (PT) and international normalised ratio (INR) are used in scoring systems (Child-Pugh, MELD, UKELD) in chronic liver disease and as a prognostic tool and for dynamic monitoring of hepatic function in acute liver disease. These tests are known to be poor predictors of bleeding risk in liver disease; however, they continue to influence clinical management decisions. Recent work on coagulation in liver disease, in particular thrombin generation studies, has led to a paradigm shift in our understanding and it is now recognised that haemostasis is relatively well preserved. Whole blood global viscoelastic tests (TEG(®) /ROTEM(®) ) produce a composite dynamic picture of the entire coagulation process and have the potential to provide more clinically relevant information in patients with liver disease. We performed a systematic review of all relevant studies that have used viscoelastic tests (VET) of coagulation in patients with liver disease. Although many studies are observational and small in size, it is clear that VET provide additional information that is in keeping with the new concepts of how coagulation is altered in these patients. This review provides the basis for large scale, prospective outcome studies to establish the clinical value of these tests.
凝血酶原时间（PT）和国际标准化比值（INR）用于慢性肝脏疾病的评分系统（Child-Pugh、MELD、UKELD）中，作为一种预后工具，并用于急性肝脏疾病中肝功能的动态监测。这些测试已知不能很好地预测肝脏疾病的出血风险；然而，它们仍然影响临床管理决策。最近关于肝脏疾病中凝血的研究，特别是关于凝血酶生成的研究，导致我们对其的理解发生了范式转变，现在人们认识到止血功能相对较好。全血整体粘弹性测试（TEG®/ROTEM®）对整个凝血过程产生综合动态图像，并有可能为肝脏疾病患者提供更具临床相关性的信息。我们对所有使用肝脏疾病患者粘弹性测试（VET）的相关研究进行了系统回顾。尽管许多研究是观察性的，且规模较小，但很明显，VET 提供了与这些患者凝血功能改变的新概念一致的额外信息。这篇综述为这些测试的临床价值的大规模前瞻性结果研究提供了基础。
