Bertaglia E, Belmonte P, Vertolli U, Azzurro M, Martines D
Haemostasis. 1983;13(5):328-34. doi: 10.1159/000214772.
In 24 cirrhotic patients at different stages of hepatic failure, factor VIII:C (F VIII:C), factor VIIIR:AG (F VIIIR:AG), factor VIII AG/C ratio (F VIII AG/C), and serum fibrin-fibrinogen degradation products (FDP) were investigated. In 11 of the 24 patients, several instances of gastrointestinal bleeding due to esophageal varices rupture were documented and 5 patients died of unarrestable bleeding. In our study, we evaluated whether the cause of bleeding was the development of intravascular coagulation or the severity of hepatic failure. A statistically significant difference between F VIII:C, F VIIIR:AG/C ratio, and serum FDP was found in bleeding in comparison with non-bleeding patients. An inverse correlation between the F VIII:C plasma level and serum FDP as well as a direct correlation between F VIII AG/C ratio and serum FDP in the group of bleeding patients were also found. These data seem to suggest a hypercoagulable state which was more significant in the 5 patients who died owing to bleeding. Furthermore, only 1 of these patients had severe hepatic failure. From this study it appears that, in cirrhotic patients, bleeding is related more to the appearance of disseminated intravascular coagulation, as a consequence of both hemodynamic and endothelial changes, than to the degree of hepatic failure itself.
对24例处于不同肝衰竭阶段的肝硬化患者，研究了因子VIII：C（F VIII：C）、因子VIIIR：AG（F VIIIR：AG）、因子VIII AG/C比值（F VIII AG/C）及血清纤维蛋白-纤维蛋白原降解产物（FDP）。24例患者中有11例记录到因食管静脉曲张破裂导致的数次胃肠道出血，5例患者死于无法控制的出血。在我们的研究中，评估出血原因是血管内凝血的发生还是肝衰竭的严重程度。与未出血患者相比，出血患者在F VIII：C、F VIIIR：AG/C比值及血清FDP方面存在统计学显著差异。在出血患者组中还发现F VIII：C血浆水平与血清FDP呈负相关，F VIII AG/C比值与血清FDP呈正相关。这些数据似乎提示存在高凝状态，在因出血死亡的5例患者中更为显著。此外，这些患者中只有1例有严重肝衰竭。从这项研究来看，在肝硬化患者中，出血似乎更多与由于血流动力学和内皮变化导致的弥散性血管内凝血的出现有关，而非肝衰竭本身的程度。
