Clinical Significance Of Thromboelastography In Patients With Liver Cirrhosis

Objective:To analyze the changes of platelet count,conventional coagulation index and thromboelastography in patients with different degrees of cirrhosis and cirrhosis with gastrointestinal hemorrhage,so as to further explore the clinical significance of thromboelastography in patients with cirrhosis.Methods:A total of 96 patients who met the diagnostic criteria of liver cirrhosis and were excluded from the patients with hematological diseases,tumors and drugs interfering with coagulation status of the Second Hospital of Jilin University from November 2017 to November 2019 were collected as the liver cirrhosis group.According to the Child-Pugh scoring standard of liver function,the patients in cirrhosis group were divided into grade A(5~6 points),grade B(7~9 points)and grade C(10~15 points).According to the occurrence of ascites,variceal hemorrhage and hepatic encephalopathy,the cirrhosis group was divided into compensated and decompensated stages.According to the occurrence of gastrointestinal hemorrhage,the cirrhosis group was divided into bleeding group and non-bleeding group.At the same time,30 physical examinees without hepatobiliary system diseases,hematological system diseases,basic diseases and drug use affecting coagulation and no tumor were collected as the control group.The age and gender of all subjects in the cirrhosis group and control group and the etiology of patients in the cirrhosis group were recorded.Blood routine,coagulation routine,liver function and thromboelastography were completed in all subjects.Results:In this study,there were 30 cases in the control group and 96 cases in the cirrhosis group,including 26 cases of Child-Pugh A,30 cases of Child-Pugh B and 40 cases of Child-Pugh C.There were 22 cases of compensated cirrhosis and 74 cases of decompensated cirrhosis.There were 28 cases in bleeding group and 68 cases in non-bleeding group.1.There was no statistical difference in age and sex ratio between the control group and Child-Pugh A,B and C groups(P > 0.05).2.Among the 96 patients in the cirrhosis group,there were 6 causes of LC.Among them,there were 47 cases of LC caused by HBV,accounting for 48.96%,followed by ALD,DILI,HCV,PBC and AIH.3.Comparison of PLT,conventional coagulation indexes and TEG test results between each group of cirrhosis and the control group:PLT count in the control group and Child-Pugh A,B,C four groups decreased gradually.The difference was statistically significant(P < 0.05).Between Child-Pugh A and Child-Pugh B two groups,the difference was not statistically significant(P > 0.05).In the routine coagulation indexes,PT,INR and APTT gradually increased in the control group and Child-Pugh A,B and C groups.The difference was statistically significant(P < 0.05).FIB and AT gradually decreased in the control group and Child-Pugh A,B and C groups.The difference was statistically significant(P < 0.05).There was no statistical difference in INR between Child-Pugh B and Child-Pugh C group(P > 0.05).There was no statistical difference in APTT between Child-Pugh A and Child-Pugh B group,and between Child-Pugh B and Child-Pugh C group(P > 0.05).There was no statistical difference in FIB between Child-Pugh A and control group,and between Child-Pugh A and Child-Pugh B group(P > 0.05).There was no statistical difference in AT between Child-Pugh A and control group or between Child-Pugh B and Child-Pugh C group(P > 0.05).In TEG,R value and K value gradually increased in the control group and Child-Pugh A,B and C groups.The difference was statistically significant(P < 0.05).ɑ Angle and MA value gradually decreased in the control group and Child-Pugh A,B and C groups.The difference was statistically significant(P < 0.05).There was no statistical difference in ɑ Angle and MA value between Child-Pugh A and Child-Pugh B group(P > 0.05).4.Comparison of PLT,conventional coagulation indexes and TEG test results between compensated cirrhosis group and control group:Compared with the control group,R value of the compensated cirrhosis group was prolonged,and PLT,ɑ Angle and MA value of the compensated cirrhosis group were decreased.The difference was statistically significant(P < 0.05).K value and routine coagulation indexes PT,INR,APTT,FIB and AT showed no statistical difference between the control group and the compensated cirrhosis group(P > 0.05).5.Comparison of PLT,conventional coagulation indexes and TEG test results between the non-bleeding group and the bleeding group of cirrhotic patients:Compared with the non-bleeding group,PLT,FIB,ɑ Angle and MA value decreased in the bleeding group,and the difference was statistically significant(P < 0.05).Other indexes such as PT,INR,APTT,AT,R value and K value showed no statistical difference between the bleeding group and the non-bleeding group(P > 0.05).Conclusion:1.TEG combined with routine coagulation indexes and PLT count can reflect the severity of patients with liver cirrhosis.2.TEG indexes are more sensitive than routine coagulation indexes to evaluate coagulation dysfunction in patients with compensated cirrhosis.3.TEG has certain value in the prediction of gastrointestinal hemorrhage in LC,which can guide clinicians to deal with coagulation abnormalities effectively.