Vucelic Dragica, Jesic Rada, Jovicic Snezana, Zivotic Maja, Grubor Nikica, Trajkovic Goran, Canic Ivana, Elezovic Ivo, Antovic Aleksandra
Clinic of Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Serbia; Clinic of Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia.
Thromb Res. 2015 Jun;135(6):1124-30. doi: 10.1016/j.thromres.2015.04.003. Epub 2015 Apr 11.
The Clauss fibrinogen method and thrombin clotting time (TCT) are still routinely used in patients with cirrhosis to define fibrinogen concentration and clotting potential. The thromboelastometric functional fibrinogen FIBTEM assay evaluates the strength of fibrin-based clots in whole blood, providing information on both quantitative deficit and fibrin polymerization disorders.
To compare these three methods of assessing fibrinogen in patients with cirrhosis of different aetiologies, characterized by impairment in fibrinogen concentration as well as functional aberrance.
Sixty patients with alcoholic and 24 patients with cholestatic cirrhosis were included (Child-Pugh score (CPs)A, n=24; B, n=32; C, n=28). All parameters were compared with those from a control group. Maximum clot firmness (MCF) in the FIBTEM test was assessed in regard to its relevance in detection of qualitative fibrinogen disorders in comparison with results obtained by standard measurement methods, i.e. the Clauss fibrinogen method and TCT.
With increased cirrhosis severity, fibrinogen and FIBTEM-MCF levels significantly declined (p=0.002), while TCT was significantly prolonged (p=0.002). In all CPs groups, fibrinogen strongly correlated with FIBTEM-MCF (r=0.77, r=0.72, r=0.74; p<0.001), while cross-correlations of other assays were highly variable. The prevalence of decreased FIBTEM-MCF values (<9 mm) was significantly higher in advanced CPs categories (p=0.027), whereby the highest prevalence was detected in patients with CPsC (10/16; 62.5%). Nine of the 16 patients with decreased FIBTEM-MCF values had also decreased fibrinogen levels, while in the remaining 7 patients fibrinogen levels were within the reference range, indicating the possible presence of qualitatively altered fibrinogen that could be detected by FIBTEM-MCF.
FIBTEM-MCF may be considered as a reliable alternative to standard plasma fibrinogen measurement in cirrhotic patients, especially in evaluating fibrin polymerization disorders in these patients. Further studies are needed to evaluate the usefulness of this assay in predicting bleeding complications in cirrhotic patients as well as monitoring replacement treatment.
在肝硬化患者中，Clauss纤维蛋白原法和凝血酶凝血时间（TCT）仍常规用于测定纤维蛋白原浓度和凝血潜能。血栓弹力图功能纤维蛋白原FIBTEM检测可评估全血中基于纤维蛋白的凝块强度，提供关于定量缺陷和纤维蛋白聚合障碍的信息。
比较这三种评估不同病因肝硬化患者纤维蛋白原的方法，这些患者的特点是纤维蛋白原浓度受损以及功能异常。
纳入60例酒精性肝硬化患者和24例胆汁淤积性肝硬化患者（Child-Pugh评分（CPs）A，n = 24；B，n = 32；C，n = 28）。将所有参数与对照组的参数进行比较。与通过标准测量方法（即Clauss纤维蛋白原法和TCT）获得的结果相比，评估FIBTEM检测中的最大凝块硬度（MCF）在检测纤维蛋白原定性障碍方面的相关性。
随着肝硬化严重程度增加，纤维蛋白原和FIBTEM-MCF水平显著下降（p = 0.002），而TCT显著延长（p = 0.002）。在所有CPs组中，纤维蛋白原与FIBTEM-MCF密切相关（r = 0.77，r = 0.72，r = 0.74；p < 0.001），而其他检测方法的交叉相关性变化很大。在晚期CPs类别中，FIBTEM-MCF值降低（<9 mm）的患病率显著更高（p = 0.027），其中CPsC患者的患病率最高（10/16；62.5%）。16例FIBTEM-MCF值降低的患者中有9例纤维蛋白原水平也降低，而其余7例患者的纤维蛋白原水平在参考范围内，这表明可能存在可通过FIBTEM-MCF检测到的定性改变的纤维蛋白原。
FIBTEM-MCF可被视为肝硬化患者标准血浆纤维蛋白原测量的可靠替代方法，尤其是在评估这些患者的纤维蛋白聚合障碍方面。需要进一步研究评估该检测在预测肝硬化患者出血并发症以及监测替代治疗中的有用性。
