HEMOSTASIS AND FIBRINOLYSIS IN SEVERE LIVER-FAILURE AND THEIR RELATION TO HEMORRHAGE
HEMOSTASIS AND FIBRINOLYSIS IN SEVERE LIVER-FAILURE AND THEIR RELATION TO HEMORRHAGE
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DOI：
10.1002/hep.1840060115
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发表时间：
1986-01-01
期刊：
影响因子：
13.5
通讯作者：
VANVLIET, HHDM
中科院分区：
文献类型：
--
作者：
BOKS, AL;BROMMER, EJP;VANVLIET, HHDM
在一项严重失代偿性肝衰竭的研究中，我们试图找到出血与止血和纤溶参数之间的相关性。研究了三组患者：酒精性肝硬化、非酒精性肝硬化和无已知既往肝病的急性肝衰竭。两组肝硬化患者在凝血或纤溶参数方面无显著差异，但非酒精性肝硬化患者肝功能受损更严重。第三组中凝血因子、抗凝血酶III、前激肽释放酶、纤溶酶原和α 2-抗纤溶酶的水平显著较低。所有三组的纤溶活性平均值（纤维蛋白平板法）与正常值相比略有降低。组织纤溶酶原激活物相关抗原有升高的趋势，尤其是在酒精性肝硬化。在所有三组中，部分患者的游离速效纤溶酶原激活物抑制剂水平极高和极低。非静脉曲张、毛细血管型出血，包括粘膜出血、血肿和穿刺部位出血，与低血栓试验和正常试验水平相关（p < 0.01），与低纤维蛋白原浓度相关（p < 0.05），与高纤溶活性商（溶解面积的平方根）和正常试验相关（p < 0.001）。纤维蛋白形成和溶解之间的比率似乎是肝病出血倾向的一个重要参数。静脉曲张出血似乎与止血或纤维蛋白溶解受损无关。
In a study of severe, decompensated liver failure, we tried to find a correlation between hemorrhage and parameters of hemostasis and fibrinolysis. Three groups of patients were studied: alcoholic cirrhosis; nonalcoholic cirrhosis, and acute liver failure without known prior liver disease. The two cirrhotic groups did not differ significantly from each other in coagulation or in fibrinolytic parameters, although liver function was more impaired in nonalcoholic cirrhosis. The levels of clotting factors, antithrombin III, prekallikrein, plasminogen and .alpha.2-antiplasmin were significantly lower in the third group. Mean values of fibrinolytic activity (fibrin plate method) were slightly reduced as compared to normal in all three groups. Tissue plasminogen activator-related antigen tended to be elevated especially in alcoholic cirrhosis. The free fast-acting plasminogen activator inhibitor showed extremely high and extremely low levels in some patients among all three groups. Nonvariceal, capillary-type bleeding, including mucosal bleeding, hematomas and bleeding from puncture sites correlated with low thrombotest and normotest levels (p < 0.01), low fibrinogen concentration (p < 0.05) and with a high quotient of fibrinolytic activity (square root of lysis area) and normotest (p < 0.001). The ratio between fibrin formation and dissolution appears to be an important parameter of hemorrhagic tendency in liver disease. Variceal bleeding appeared not to be related to impairment of hemostasis or fibrinolysis.