El Bokl Mohamed A, Shawky Amal, Riad George S, Abdel Fattah Hisham S, Shalaby Hassan, Nady Ahmed, Khattab Dina
Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Internal Medicine, Faculty of Medicine, Misr University for Science and Technology, Cairo, Egypt.
Arab J Gastroenterol. 2014 Sep-Dec;15(3-4):123-9. doi: 10.1016/j.ajg.2014.08.003. Epub 2014 Sep 22.
Liver cirrhosis leads to decreased production of clotting factors that are generally all produced in the liver except factor VIII and von Willebrand factor. However, cirrhotic patients are not protected from thrombosis. The present study aimed to assess the procoagulant and anticoagulant factors in cirrhotic patients with and without bleeding and/or thrombotic events.
A total of 102 adult subjects were enroled: 51 cirrhotic patients and 51 healthy controls. After full history taking with special attention given to thromboembolic and haemorrhagic events, platelet count, serum albumin, bilirubin, international normalised ratio (INR), PT, partial thromboplastin time (PTT), hepatitis B surface antigen (HBsAg), hepatitis B core (HBc) antibodies, hepatitis C virus (HCV) antibodies, factor VIII, protein C, Protac-induced coagulation inhibition percentage (PICI%) assay and abdominal ultrasound were performed for patients and controls. Upper gastrointestinal endoscopy was conducted for the patients.
Compared with control subjects, factor VIII and factor VIII/protein C were significantly higher, while protein C and PICI% were significantly lower among patients.
Patients with liver cirrhosis may have a tendency for bleeding or thrombosis according to the balance of coagulant and anticoagulant status. PICI%, the assay that evaluated the functionality of the protein C anticoagulant system, was significantly lower in patients compared to control subjects. Accordingly, low PICI% and high factor VIII/protein C ratio can be taken as an index of hypercoagulability in cirrhotic patients.
肝硬化会导致凝血因子生成减少，除因子VIII和血管性血友病因子外，凝血因子通常都在肝脏中产生。然而，肝硬化患者并非不会发生血栓形成。本研究旨在评估有和无出血及/或血栓形成事件的肝硬化患者的促凝血和抗凝血因子。
共纳入102名成年受试者：51名肝硬化患者和51名健康对照者。在详细询问病史并特别关注血栓栓塞和出血事件后，对患者和对照者进行血小板计数、血清白蛋白、胆红素、国际标准化比值（INR）、凝血酶原时间（PT）、活化部分凝血活酶时间（PTT）、乙型肝炎表面抗原（HBsAg）、乙型肝炎核心（HBc）抗体、丙型肝炎病毒（HCV）抗体、因子VIII、蛋白C、凝血酶原激活物诱导的凝血抑制百分比（PICI%）检测以及腹部超声检查。对患者进行上消化道内镜检查。
与对照者相比，患者的因子VIII和因子VIII/蛋白C显著升高，而蛋白C和PICI%显著降低。
肝硬化患者根据促凝血和抗凝血状态的平衡可能有出血或血栓形成的倾向。与对照者相比，评估蛋白C抗凝血系统功能的检测指标PICI%在患者中显著降低。因此，低PICI%和高因子VIII/蛋白C比值可作为肝硬化患者高凝状态的指标。
