Hypercoagulability in patients with primary biliary cirrhosis and primary sclerosing cholangitis evaluated by thrombelastography
Hypercoagulability in patients with primary biliary cirrhosis and primary sclerosing cholangitis evaluated by thrombelastography
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DOI：
10.1016/s0168-8278(97)80420-5
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发表时间：
1997-03-01
影响因子：
25.7
通讯作者：
Burroughs, A
中科院分区：
文献类型：
--
作者：
BenAri, Z;Panagou, M;Burroughs, A
背景/目标：原发性胆汁性肝硬化和原发性硬化性胆管炎患者在静脉曲张出血后的存活率高于酒精性肝硬化患者，并且在肝移植时出血较少。近年来，原发性胆汁性肝硬化患者门静脉树血栓形成的发生率较高，我们推测原发性胆汁性肝硬化和原发性硬化性胆管炎患者可能存在高凝状态。我们使用血栓弹性描记术，这是一种评价全血凝固和纤维蛋白溶解的简单技术，以确定是否存在高凝状态，定义为血栓弹力图值大于对照组的2SD：r60 mm，α角>43度我们评估了47例原发性胆汁性肝硬化和21例原发性硬化性胆管炎患者，对40例非胆汁淤积性肝硬化患者和40例健康对照者进行血栓弹力图、全血细胞计数、凝血酶原时间、部分凝血活酶时间和纤维蛋白原测定，对高凝状态患者进行蛋白S、蛋白C、抗凝血酶III水平和活化蛋白C表型测定。所有这三种血栓弹力图异常共同表现为高凝状态：在47例原发性胆汁性肝硬化患者中有13例（28%），在21例原发性硬化性胆管炎患者中有9例（43%），与肝硬化和胆红素浓度无关，但在40例非胆汁淤积性肝硬化患者中只有2例（5%），在健康对照组中无一例（P > 0.05）。
Background/Aims: Patients with primary biliary cirrhosis and primary sclerosing cholangitis survive variceal bleeding better than patients with alcoholic cirrhosis and have less bleeding at liver transplantation. Recently, patients with primary biliary cirrhosis have been found to have a higher incidence of thrombosis in the portal venous tree, We hypothesized that primary biliary cirrhosis and primary sclerosing cholangitis patients may be hypercoagulable.Methods: We used thrombelastography, which is a simple technique for evaluating whole blood clotting and fibrinolysis, to establish if hypercoagulability was present, defined by thrombelastography values greater than 2SD over controls: r60 mm, and alpha angle >43 degrees (these reflect platelets and fibrinogen levels), We evaluated 47 primary biliary cirrhosis and 21 primary sclerosing cholangitis patients, 40 with non-cholestatic cirrhosis and 40 healthy subjects as control groups with thrombelastography, full blood count, prothrombin time, partial thromboplastin time and, fibrinogen concentrations, In those with hypercoagulability we evaluated protein S, C, anti-thrombin III levels and activated protein C phenotype.Results: All three thrombelastography abnormalities present together defined hypercoagulability: these were found in 13 of 47 (28%) primary biliary cirrhosis and in nine of 21 (43%) primary sclerosing cholangitis patients independent of cirrhosis, and bilirubin concentration, but in only 2 of 40 (5%) patients with noncholestatic cirrhosis and in none of the healthy controls (p