接受经颈静脉肝内门体分流术（TIPS）的肝硬化患者门静脉和外周循环的旋转血栓弹力图测量结果无差异。
No Differences in Rotational Thromboelastometry Measurements between Portal and Peripheral Circulation in Cirrhotic Patients Undergoing TIPS.
作者信息
Bedreli Sotiria, Manka Paul, Buechter Matthias, Jahn Michael, Theysohn Jens M, Canbay Ali, Katsounas Antonios
机构信息
Department of Internal Medicine and Gastroenterology, Marienhospital Gelsenkirchen, 45886 Gelsenkirchen, Germany.
Department of Medicine, University Hospital Knappschaftskrankenhaus Bochum, 44892 Bochum, Germany.
出版信息
J Pers Med. 2023 Feb 26;13(3):424. doi: 10.3390/jpm13030424.
BACKGROUND
In patients with liver cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) is considered a standardized treatment of refractory ascites or variceal bleeding. TIPS thrombosis (TT) and/or portal vein thrombosis (PVT) are possible complications during/after TIPS placement. Previous studies suggested increased clotting activity in portal circulation (PORC). This pilot study aimed to evaluate alterations and differences of coagulation function in PORC and in peripheral circulation (PERC) via rotational thromboelastometry during TIPS.
METHODS
Blood samples were collected from cirrhotic patients ( = 13; median Model of End Stage Liver Disease, MELD Score: 12; median age: 60 years) undergoing TIPS (10/13 TIPSs were elective procedures due to refractory ascites) as follows: median cubital vein (MCV; PERC)-confluence of the three hepatic veins to the inferior cava vein (HV/ICV; PORC)-portal vein (PV; PORC)-TIPS (PORC). This research utilized four variables of the extrinsic test EXTEM, i.e., clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), and maximum lysis (ML).
RESULTS
EXTEM results [mean, M (range) ± standard deviation, SD (range)] showed no significant differences for CT [M (70-73) ± SD (9-13); = 0.93] or CFT [M (137-155) ± SD (75-112); = 0.97] or MCF [M (51-54) ± SD (9-10); = 0.90] or ML [M (9-10) ± SD (4-5); = 0.89] between the compartments, i.e., MCV vs. HV/ICV vs. PV vs. TIPS. Overall, we detected no differences in coagulation function between PERC and PORC.
CONCLUSION
These results are in contrast to previous reports suggesting increased clotting activity in PORC vs. PERC in association with liver cirrhosis. Rotational thromboelastometry-based evaluation of coagulation function in PERC appears to reliably reflect coagulation function in PORC with respect to risk estimation for TT and/or PVT in cirrhotic patients undergoing TIPS.
背景
在肝硬化患者中，经颈静脉肝内门体分流术（TIPS）被认为是治疗难治性腹水或静脉曲张破裂出血的标准化治疗方法。TIPS血栓形成（TT）和/或门静脉血栓形成（PVT）是TIPS放置期间/之后可能出现的并发症。先前的研究表明门静脉循环（PORC）中的凝血活性增加。这项初步研究旨在通过旋转血栓弹力图评估TIPS期间PORC和外周循环（PERC）中凝血功能的变化和差异。
方法
从接受TIPS的肝硬化患者（n = 13；终末期肝病模型，MELD评分中位数：12；年龄中位数：60岁）中采集血样（10/13例TIPS是由于难治性腹水而进行的择期手术），采集顺序如下：肘正中静脉（MCV；PERC）-三条肝静脉与下腔静脉汇合处（HV/ICV；PORC）-门静脉（PV；PORC）-TIPS（PORC）。本研究使用了外源性检测EXTEM的四个变量，即凝血时间（CT）、凝血形成时间（CFT）、最大凝血硬度（MCF）和最大溶解率（ML）。
结果
EXTEM结果[平均值，M（范围）±标准差，SD（范围）]显示，各部位之间的CT[M（70 - 73）±SD（9 - 13）；P = 0.93]、CFT[M（137 - 155）±SD（75 - 112）；P = 0.97]、MCF[M（51 - 54）±SD（9 - 10）；P = 0.90]或ML[M（9 - 10）±SD（4 - 5）；P = 0.89]无显著差异，即MCV与HV/ICV与PV与TIPS之间。总体而言，我们未检测到PERC和PORC之间凝血功能的差异。
结论
这些结果与先前的报告相反，先前报告表明与肝硬化相关的PORC与PERC相比凝血活性增加。对于接受TIPS的肝硬化患者，基于旋转血栓弹力图对PERC中凝血功能的评估似乎能可靠地反映PORC中的凝血功能，用于TT和/或PVT的风险评估。
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