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目的比较、分析晚期血吸虫病肝硬化和乙型肝炎肝硬化患者凝血功能相关参数在不同肝功能分级下的差异,为临床病情及预后的判断提供进一步的指导依据。方法选择荆州市中心医院2014年1月-2016年6月期间住院的晚期血吸虫病肝硬化患者63例、乙型肝炎肝硬化患者80例分别作为血吸虫肝硬化组和乙肝肝硬化组;选择同期因胃病住院并排除患其他可能影响凝血功能疾病的患者96例作为对照组,检测并比较3组凝血相关参数值,以及不同Child-Pugh分级下晚期血吸虫病肝硬化和乙型肝炎肝硬化患者相关参数值。结果 3组凝血酶原时间(PT)、国际标准化比率(INR)、纤维蛋白原(Fib)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、血小板(PLT)水平差异均有统计学意义(F=84.512、81.672、37.612、104.475、52.497、102.233,P均<0.05)。两两比较显示,血吸虫病和乙肝肝硬化患者的PT、INR、TT、APTT均较对照组明显延长,PLT均明显减少,差异均有统计学意义(P均<0.05)。与血吸虫病肝硬化组相比,乙肝肝硬化患者PT、INR、TT、APTT时间均明显延长,Fib及PLT明显下降,差异均有统计学意义(P均<0.05)。肝功能分级为Child-Pugh A级时,乙肝肝硬化患者PLT减少程度较重;但当肝功能分级为Child-Pugh B、C级时,2组患者PLT计数差异无统计学意义(P均>0.05)。各分级下,乙肝肝硬化组TT、APTT均较血吸虫病肝硬化组延长,且Fib水平均明显下降。而乙肝肝硬化组PT、INR值仅在肝功能为Child-Pugh A、B级时较血吸虫病肝硬化组延长;在肝功能为C级时,两组差异无统计学意义(P均>0.05)。结论晚期血吸虫病肝硬化患者和乙型肝炎肝硬化患者凝血功能损害程度存在差异。在肝功能受损程度较轻时,后者凝血功能下降更明显;肝功能受损严重时,后者内源性凝血途径的影响更为明显,外源性凝血途径的影响及PLT减少在两类患者中差异不大。
Objective To compare and analyze the differences of coagulation-related parameters in patients with advanced schistosomiasis cirrhosis and hepatitis B cirrhosis patients under different grading of liver function, and to provide further guidance for the judgment of clinical condition and prognosis. Methods 63 cases of advanced schistosomiasis cirrhosis hospitalized in Jingzhou Central Hospital from January 2014 to June 2016 were enrolled, 80 cases of hepatitis B cirrhosis were used as schistosome cirrhosis group and hepatitis B cirrhosis group respectively. Gastric disease hospitalized and excluded from other patients may affect coagulation disorders in 96 patients as a control group, detection and comparison of three groups coagulation-related parameters, and different Child-Pugh classification of advanced schistosomiasis patients with cirrhosis and hepatitis B cirrhosis related parameters value. Results The differences of PT, INR, Fib, TT, APTT and PLT between the three groups were statistically significant Statistical significance (F = 84.512,81.672,37.612,104.475,52.497,102.233, P <0.05). The comparison between the two groups showed that PT, INR, TT, APTT in patients with schistosomiasis and hepatitis B cirrhosis were significantly longer than those in control group, PLT were significantly reduced, the differences were statistically significant (P all <0.05). Compared with schistosomiasis cirrhosis group, the duration of PT, INR, TT and APTT in patients with hepatitis B cirrhosis were significantly prolonged, while the levels of Fib and PLT were significantly decreased (all P <0.05). When the liver function was graded as Child-Pugh class A, the reduction of PLT in patients with hepatitis B cirrhosis was severe. However, when the liver function was graded as Child-Pugh B and C, there was no significant difference in PLT count between the two groups (P> 0.05). Under each grading, TT and APTT of hepatitis B cirrhosis group were longer than that of schistosomiasis cirrhosis group, and Fib levels were significantly decreased. The values of PT and INR in hepatitis B cirrhosis group were longer than those in schistosomiasis cirrhosis group only when the liver function was Child-Pugh A and B grade, but there was no significant difference between the two groups (P> 0.05) ). Conclusion There is a difference in the extent of coagulopathy between patients with advanced cirrhosis and patients with hepatitis B cirrhosis due to schistosomiasis. In the lesser degree of impaired liver function, the coagulation function decreased more obviously. When the impaired hepatic function was serious, the effect of the latter’s coagulation pathway was more obvious. The effect of extrinsic coagulation pathway and PLT decreased in two Little difference in patients.