| Objective:This study retrospectively analyzed the changes of coagulation,anticoagulation and fibrinolysis systems in patients with cirrhosis,the differences of coagulation,anticoagulation and fibrinolysis systems in patients with cirrhosis with different Child-Pugh grading of liver function,and the changes in coagulation,anticoagulation and fibrinolysis systems in patients with cirrhosis along with bleeding and/or thrombosis,the relationship between different Child-Pugh grading of liver function and cirrhosis hemorrhage and/or thrombosis by statistical methods,to provide a certain clinical basis for the diagnosis,treatment and prognosis of patients with post-hepatitis B cirrhosis.Methods: 1.Collect the clinical data of 68 in patients with post-hepatitis B cirrhosis who were hospitalized and confirmed from July 2018 to April 2019 in the Department of Infectious Diseases of the First Hospital of Lanzhou University as the observation group;2.Collect clinical data of 30 healthy people in the same period according to relevant exclusion conditions as control group;3.Analysis differences in two groups of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),coagulation factors(Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅺ),von Willebrand factor(vWF)antigen,antithrombin(AT),protein C(PC),protein S(PS),fibrinogen degradation product(FDP),D-dimer(DD)and plasminogen(PLG)activity;4.According to Child-Pugh liver function classification,patients with liver cirrhosis were divided into Child-Pugh grade A(15 cases),Child-Pugh grade B(34 cases),Child-Pugh grade C(19 cases),and the differences between the above indicators were analyzed between different Child-Pugh liver function grades;5.Patients with cirrhosis were divided into bleeding group(9 cases)and non-bleeding group(59 cases)according to whether there was upper gastrointestinal bleeding,and the changes ofthe above indicators during bleeding were analyzed;6.Patients with cirrhosis were divided into thrombus group(15 cases)and non thrombus group(53 cases)according to whether there was portal vein thrombosis,and the changes of the above indicators in the occurrence of thrombosis were analyzed;7.To analyze the relationship between Child-Pugh liver function grade and upper gastrointestinal bleeding and/or portal venous thrombosis adverse events in patients with cirrhosis.Results:1.Compared with the healthy control group,plasma prothrombin time,activated partial thromboplastin time,thrombin time,fibrinogen degradation products,D-dimer,coagulation factor Ⅷ and von Willebrand factor were increased in patients with cirrhosis,the difference was statistically significant(P<0.05);plasma fibrinogen,coagulation factors(Ⅱ 、 Ⅴ 、 Ⅶ 、 Ⅺ),antithrombin,protein C,protein S and plasminogen were all decreased in patients with cirrhosis,and the difference was statistically significant(P<0.05).2.With the increase of Child-Pugh liver function grade,plasma prothrombin time,activated partial thromboplastin time,thrombin time,von Willebrand factor,fibrinogen degradation product,D-dimer showed an increasing trend in patients with cirrhosis;prothrombin time,activated partial thromboplastin time,von Willebrand factor,fibrinogen degradation product,D-dimer were statistically significant between Child-Pugh liver function grade A and grade C and between Child-Pugh liver function grade B and grade C(p<0.05);and thrombin time was statistically significant between Child-Pugh liver function grades(p<0.05).3.With the increase of Child-Pugh liver function grade,plasma fibrinogen,coagulation factors(Ⅱ、Ⅴ、Ⅶ、Ⅺ),antithrombin,protein C,protein S,plasminogen showed a downward trend in patients with cirrhosis;fibrinogen,coagulation factors(Ⅱ、Ⅶ、Ⅺ),antithrombin,protein C,and plasminogen were statistically significant between Child-Pugh liver function grades(p<0.05);Coagulation factor Ⅴ and protein S were statistically significant between Child-Pugh liver function grade A and grade C and between Child-Pugh liver function grade B and grade C(p<0.05).4.With the increase of Child-Pugh liver function grade,there was no significant change in Coagulation factor Ⅷ,and there was no statistical significance between Child-Pugh liver function grades(p>0.05).5.Compared with the non-bleeding group,plasma prothrombin time,activated partial thromboplastin time,thrombin time,von Willebrand factor,fibrinogen degradation products and D-dimer were all increasing in the cirrhosis bleeding group,the difference was statistically significant(p <0.05);plasma fib,coagulation factors(Ⅱ、Ⅴ、Ⅶ、Ⅺ),antithrombin,protein C,protein S and plasminogen were all decreasing,the difference was statistically significant(p <0.05);plasma coagulation factor Ⅷ was not statistically significant between the two groups(p>0.05).6.Compared with the non-thrombotic group,plasma prothrombin time,activated partial thromboplastin time,thrombin time,von Willebrand factor,fibrinogen degradation products and D-dimer were all increasing in the cirrhosis thrombosis group,the difference was statistically significant(p <0.05);plasma fib,coagulation factors(Ⅱ、Ⅴ、Ⅶ、Ⅺ),antithrombin,protein C,protein S and plasminogen were all decreased,the difference was statistically significant(p <0.05);there was no significant change in plasma coagulation factor Ⅷ,and the difference was not statistically significant(p> 0.05).7.In patients with liver cirrhosis,adverse events such as bleeding and / or thrombosis often occurred in patients with Child-Pugh liver function grading C;the bleeding group(9 cases)were all Child-Pugh liver function grading C patients,accounting for 47.4% of patients with Child-Pugh liver function grade C;In the thrombosis group(15 cases),only one was Child-Pugh liver function grading B patient,accounting for 2.9% of patients with Child-Pugh liver function grading B,and the other 14 patients were all Child-Pugh liver function grading C patients,accounting for73.7% of patients with Child-Pugh liver function grade C;There were 3 cases accompanied by hemorrhage and thrombosis,and all were Child-Pugh liver function grading C patients,accounting for 15.8% of patients with Child-Pugh liver function grade C.Conclusion: 1.Patients with cirrhosis are often accompanied by abnormal changes in the coagulation,anticoagulation and fibrinolysis system.The higher the Child-Pugh liver function grading,the more obvious the abnormality of the coagulation,anticoagulation and fibrinolysis system,showing more severe bleeding and coagulation disorders;2.Compared with patients without hemorrhage in cirrhosis,patients with hemorrhage in cirrhosis exhibit more severe bleeding and coagulation dysfunction;3.Compared with patients without thrombosis in cirrhosis,patients with thrombosis in cirrhosis have more severe bleeding and coagulation dysfunction;4.Bleeding and/or thrombotic adverse events in patients with cirrhosis are associated with Child-Pugh liver function grading.The higher the Child-Pugh liver function grading,the higher the risk of bleeding and/or thrombotic events.Therefore,thedetection of coagulation,anticoagulation and fibrinolysis indicators in patients with cirrhosis can provide a reference for the diagnosis,severity of disease,prognosis,bleeding and / or thrombotic events of cirrhosis,and has important clinical value for guiding treatment. |
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