Can the Screening Clotting Tests Predict the Complicated Hemostatic Changes in Patients with Cirrhosis of Liver?

為了評估肝硬化病人的凝血改變，我們在51個肝硬化病人和33個健康的對照組進行以下一系列的凝血試驗及參數測定，包含：活化部分血栓質時問（APTT），凝血酵素元時問（PT），凝血酵素時間（TT），出血時間（BT），第八因子定量，抗凝血酵素（ATⅢ）活性，纖維蛋白原，胞漿素，魚精蛋白硫酸鹽試驗（PST），纖維蛋白（原）分解物（FDP），D-雙聚體，凝血酵素－抗凝血酵素複合物（TAT）（利用修正抗凝血酵素測定，（ATM），組織胞漿素原活化劑（tPA），胞漿素原活化劑抑制劑1（PAI-1），優球蛋白溶解時間（ELY）和靜脈阻塞試驗。肝硬化病人的第八因子，ATM，PAI，tPA，D-雙聚體和FDP較健康者高，纖維蛋白原，胞漿素原，血小板和ATⅢ則較低，ELT較短，而APTT，PT，TT和BT則較長。當肝硬化病人分別以APTT，PT，TT或BT之長短各分成3小組，凝血參數的最大差異，以APTT劃分成之三小組差異最大。在另一方面，PT和其他凝血參數有最多的相關性。因此在常用之篩檢試驗中，APTT和PT是最能作為肝硬化凝血改變的試驗。而ATⅢ和胞漿素原是最能指出凝血和纖維蛋白溶解參數改變的代表參數。我們建議，除了慣常的篩檢試驗之外，還可測定ATⅢ和胞漿素原以獲得更多可參考的結果。在肝硬化中，纖維蛋白的增加可能是原發性的，因為在研究中未能發現TAT與纖維蛋白原，D-雙聚體，FDP，胞漿素原，PAI，ELT或是tPA有直接的關係。雖然肝硬化病人的tPA及PAI會增加，而ELT會縮短，但VOT-誘發纖維蛋白溶解活力之改變在肝硬化病人和對照組之間並無有意義的不同。因此，肝硬化病人在壓力下之纖維蛋溶解活力並沒有產生障礙。

關鍵字

凝血改變；肝硬化；纖維蛋自溶解活力；篩檢試驗

並列摘要

In order to evaluate the homeostatic changes in patients with cirrhosis of liver, a series of haemostatic tests and parameters including activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), bleeding time (BT), factor Ⅷ assay, antithrombin Ⅲ (ATⅢ) activity, fibrinogen, plasminogen, protamine sulfate test (PST), fibrin (ogen) degradation product (FDP), D-dimer, thrombin-antithrombin Ⅲ complex (TAT) (measured by modified antithrombin Ⅲ, ATM), tissue plasminogen activator (tPA), plasminogen activator inbibitor-1 (PAI), euglobulin lysis test (ELT)and venous occlusion test (VOT)were performed in 51 cases of cirrhosis of live and 33 healthy controls. Factor Ⅷ, ATM, PAI, tPA. D-dimer and FDP were higher, fibrinogen, plasminogen, platelet and AT Ⅲ were lower, ELT was shorter and APTT, PT, TT and BT were longer in the cirrhotics than in the controls. When the cirrhotic patients were divided into 3 subgroups by different time ranges of APTT, the greatest difference of the hemostatic parameters was noted rather than by different time ranges of PT, TT or BT. On the other hand. PT had significant correlation with most of the other hemostasis parameters. Thus, among the most frequently used screening tests, APTT and PT were the most capable of demonstrating the homeostatic change in liver cirrhosis. AT Ⅲ and plasminogen were the most representative parameters to demonstrate the changes of the coagulation and the fibrinolysis parameters, respectively. We thus suggested that AT Ⅲ and plasminogen be performed in addition to the conventional screening tests to get more referential results. The increased fibrinolysis in liver cirrhosis might be primary, since TAT was not found to correlate well with fibrinogen. D-dimer, FDP, plasminogen, PAI, ELT or tPA in the present study. The VOT-induced fibrinolytic change was not significantly different between the cirrhotics and the controls, though increases of tPA and PAI and shortening of ELT were found in the cirrhotics. Thus, the fibrinolytic activity after stress was not impaired in patients with liver cirrhosis.

並列關鍵字

fibrinolytic activity ； hemostatic change ； liver cirrhosis ； screening tests

國際替代計量

Can the Screening Clotting Tests Predict the Complicated Hemostatic Changes in Patients with Cirrhosis of Liver?

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