Tang Wen, Wang Yu, Zhao Xinyan, Wang Xiaoming, Zhang Tao, Ou Xiaojuan, Shou Weiling, You Hong, Jia Jidong
aLiver Research Center, Beijing Friendship Hospital, Capital Medical University bBeijing Key Laboratory of Translational Medicine in Liver Cirrhosis cDepartment of Laboratory Medicine, Peking Union Medical College Hospital, Beijing, China.
Eur J Gastroenterol Hepatol. 2015 Jun;27(6):672-8. doi: 10.1097/MEG.0000000000000352.
Hypercoagulability, hemodynamic changes, and endothelial injury are the three major contributors to the development of thrombosis. However, the role of hypercoagulability in portal vein thrombosis (PVT) in liver cirrhosis is still controversial. The aim of this study is to elucidate the relationship between procoagulant imbalance and PVT in patients with liver cirrhosis.
This study included 151 patients with cirrhosis with (n=20) or without PVT (n=131). Levels of procoagulant factor (FVIII) and anticoagulants [protein C (PC), protein S (PS), and antithrombin (AT)] were measured. Procoagulant imbalance was also evaluated using a thrombin generation test with/without Protac and the results were expressed as Protac-induced coagulation inhibition percentage (PICI%). The lower the PICI% value, the greater the procoagulant imbalance.
The levels of PC (P<0.001), PS (P<0.05), and AT (P<0.001) decreased progressively from Child-Pugh A to C in all patients, whereas the levels of FVIII did not alter with the severity of cirrhosis (P>0.05), which indicated the balance tilting toward procoagulation in liver cirrhosis. Similarly, the PICI% values decreased from Child-Pugh A to C (P<0.001). However, there were no differences in the levels of PC, PS, AT, FVIII or PICI% between patients with and without PVT (P>0.05), even after stratification by Child-Pugh classification (P>0.05).
Procoagulant imbalance is not associated with the presence of PVT in patients with cirrhosis, although the imbalance worsens with the severity of cirrhosis.
高凝状态、血流动力学改变和内皮损伤是血栓形成的三大主要因素。然而，高凝状态在肝硬化门静脉血栓形成（PVT）中的作用仍存在争议。本研究旨在阐明肝硬化患者促凝失衡与PVT之间的关系。
本研究纳入了151例肝硬化患者，其中有PVT者20例，无PVT者131例。检测促凝因子（FVIII）和抗凝因子[蛋白C（PC）、蛋白S（PS）和抗凝血酶（AT）]的水平。还使用含/不含Protac的凝血酶生成试验评估促凝失衡情况，结果以Protac诱导的凝血抑制百分比（PICI%）表示。PICI%值越低，促凝失衡越严重。
所有患者中，PC（P<0.001）、PS（P<0.05）和AT（P<0.001）水平从Child-Pugh A级到C级逐渐降低，而FVIII水平不随肝硬化严重程度改变（P>0.05），这表明肝硬化中凝血平衡倾向于促凝。同样，PICI%值从Child-Pugh A级到C级降低（P<0.001）。然而，有PVT和无PVT的患者在PC、PS、AT、FVIII水平或PICI%方面无差异（P>0.05），即使按Child-Pugh分类分层后也是如此（P>0.05）。
肝硬化患者中促凝失衡与PVT的存在无关，尽管这种失衡会随着肝硬化严重程度的增加而恶化。
