Rogalski Pawel, Rogalska-Plonska Magdalena, Wroblewski Eugeniusz, Kostecka-Roslen Ines, Dabrowska Milena, Swidnicka-Siergiejko Agnieszka, Wasielica-Berger Justyna, Cydzik Mariusz, Hirnle Tomasz, Dobrzycki Slawomir, Flisiak Robert, Dabrowski Andrzej
a Department of Gastroenterology and Internal Medicine , Medical University of Bialystok , Bialystok , Poland.
b Department of Infectious Diseases and Hepatology , Medical University of Bialystok , Bialystok , Poland.
Scand J Gastroenterol. 2019 Mar;54(3):311-318. doi: 10.1080/00365521.2019.1578822. Epub 2019 Mar 23.
The study aimed at assessing the effect of thrombocytopenia and platelet function abnormalities on the occurrence of variceal bleeding in patients with cirrhosis. The results of impedance aggregometry, von Willebrand factor antigen level and thromboelastometry (TEM) with and without the addition of a platelet inhibitor (FIBTEM, EXTEM test, respectively) were compared in two patient groups: Group 1 ( = 32) - patients with moderate or large esophageal or gastric varices, who had never had symptoms of acute gastrointestinal bleeding and Group 2 ( = 26) - patients with history of variceal bleeding. Standard clotting test indicated more hypocoagulable profile in Group 2 compared to Group 1. However, no differences in any TEM component were observed between groups in EXTEM test. The contribution of platelets to clot strength was significantly higher in Group 2 than in Group 1 [PLT% = 74.2 (67.5-80.4) versus 68.8 (63.7-76.5) %; = .039]. The aggregation index was also higher in Group 2 compared to Group 1, although not statistically significant [% of healthy = 96.9 (73.2-140.1) versus 67.6 (52.5-118.8) %, = .195]. No differences in vWF antigen levels were observed between groups. The results of thromboelastometry and aggregometry indicate increased contribution of platelets in clot formation in patients with a history of variceal bleeding compared to cirrhotic patients who never bled. Comparable effectiveness of hemostasis in both groups is most likely associated with the compensatory role of platelets. Increased platelet activity in this group of patients is probably due to a mechanism independent of the von Willebrand factor antigen level.
该研究旨在评估血小板减少和血小板功能异常对肝硬化患者静脉曲张出血发生的影响。在两组患者中比较了添加血小板抑制剂（分别为FIBTEM、EXTEM试验）前后的阻抗聚集测定、血管性血友病因子抗原水平和血栓弹力图（TEM）结果：第1组（n = 32）——患有中度或大型食管或胃静脉曲张、从未有过急性胃肠道出血症状的患者；第2组（n = 26）——有静脉曲张出血史的患者。标准凝血试验表明，与第1组相比，第2组的凝血功能更低。然而，在EXTEM试验中，两组之间未观察到任何TEM成分的差异。第2组中血小板对血凝块强度的贡献显著高于第1组[血小板百分比=74.2（67.5 - 80.4）%对68.8（63.7 - 76.5）%；P = 0.039]。第2组的聚集指数也高于第1组，尽管无统计学意义[健康对照百分比=96.9（73.2 - 140.1）%对67.6（52.5 - 118.8）%，P = 0.195]。两组之间未观察到血管性血友病因子抗原水平的差异。血栓弹力图和聚集测定结果表明，与从未出血的肝硬化患者相比，有静脉曲张出血史的患者血小板在血凝块形成中的贡献增加。两组止血效果相当可能与血小板的代偿作用有关。该组患者血小板活性增加可能是由于一种独立于血管性血友病因子抗原水平的机制。
