凝血指标在肝纤维化进展中的作用分析

区永光 夏汝年 梁灵

【摘要】 目的：探討凝血指标在肝纤维化进展中的作用。方法：选取2017年3月-2020年2月本院收治的276例慢性乙肝患者的临床资料进行回顾性分析，根据有无肝硬化将其分为肝硬化组（n=62）与单纯慢乙肝组（n=214）。另选取30例同期于本院进行健康体检者作为健康对照组。比较三组入院时的凝血酶原时间（PT）、凝血酶原活动度（PTA）、凝血酶时间（TT）、部分活化凝血酶时间（APTT）与纤维蛋白原（FIB），分析上述指标与慢性乙肝患者进展为肝硬化的相关性及预测价值。结果：肝硬化组的PT、TT与APTT均高于健康对照组及单纯慢乙肝组，而PTA与FIB均低于健康对照组及单纯慢乙肝组（P<0.05）。慢性乙肝患者进展为肝硬化与PT、TT与APTT呈正相关，而与PTA及FIB呈负相关（P<0.05）。ROC曲线分析显示，PT、FIB、TT、PTA、APTT联合预测曲线下面积（AUC）最高，对预测慢性乙肝患者进展为肝硬化的敏感度为0.806，特异度为0.911。结论：随着慢性乙肝患者肝纤维化进展至肝硬化，其凝血功能下降，凝血指标PT、FIB、TT、PTA与APTT联合检测对于慢性乙肝患者发生肝硬化的预测有一定应用价值。

【关键词】 凝血指标 慢性乙型肝炎 肝纤维化 肝硬化

The Role of Coagulation Index in the Development of Liver Fibrosis/OU Yongguang， XIA Runian， LIANG Ling. //Medical Innovation of China， 2021， 18（07）： -133

[Abstract] Objective： To explore the role of coagulation index in the progress of liver fibrosis. Method： Clinical data of 276 patients with chronic hepatitis B admitted to our hospital from March 2017 to February 2020 were retrospectively analyzed， and they were divided into cirrhosis group （n=62） and chronic hepatitis B group （n=214） according to the presence or absence of cirrhosis. Another 30 healthy subjects underwent physical examination in the same period were selected as the healthy control group. The prothrombin time （PT）， prothrombin activity （PTA）， thrombin time （TT）， partially activated thrombin time （APTT） and fibrinogen （FIB） at admission in the three groups were compared， and the correlation and predictive value of the above indexes with the progression to cirrhosis in patients with chronic hepatitis B were analyzed. Result： The PT， TT and APTT in the cirrhosis group were higher than those in healthy control group and simple chronic hepatitis B group， while the PTA and FIB were lower than those in the healthy control group and the chronic hepatitis B group （P<0.05）. The progression of cirrhosis in patients with chronic hepatitis B were positively correlated with PT， TT and APTT， but negatively correlated with PTA and FIB （P<0.05）. ROC curve analysis showed that the combined prediction area under the curve （AUC） of PT， FIB， TT， PTA and APTT was the highest， with a sensitivity of 0.806 and a specificity of 0.911 for predicting the progression of cirrhosis in patients with chronic hepatitis B. Conclusion： With the progression of liver fibrosis in patients with chronic hepatitis B to cirrhosis， the coagulation function decreased. The combined detection of PT， FIB， TT， PTA and APTT has a certain application value for the prediction of liver cirrhosis in patients with chronic hepatitis B.

[Key words] Coagulation index Chronic hepatitis B Liver fibrosis Cirrhosis

First-authors address： Zhaoqing Hospital of Traditional Chinese Medicine， Zhaoqing 526020， China

doi：10.3969/j.issn.1674-4985.2021.07.031

肝纤维化是肝脏对各种原因所致肝损伤做出的一种创伤愈合反应，主要病理变化为肝组织内细胞外基质过度增生与沉积，会导致肝脏结构或功能发生异常，随着肝纤维化的发生与发展，可能造成肝硬化甚至是肝癌[1-2]。肝纤维化的早期诊断对于慢性乙肝患者肝硬化的预防、治疗及预后均占据着重要作用。2015年WHO慢性乙肝防治指南中将肝脏穿刺活体组织病理学检查作为肝纤维化诊断的金标准，但因其属于有创检查，难以被患者接受而在临床难以广泛开展[3-5]。近年来，随着临床研究的深入开展，疾病相关生物标志物被陆续发现，无创诊断技术被更多地应用于临床[6]。既往研究指出，凝血因素与炎症反应共同促成了肝脏纤维化的进展[7]。炎症因子与肝纤维化的关系已被诸多临床研究数据证实[8-10]。……