出凝血四项及总胆汁酸联合检测对肝病患者的意义

出凝血四项及总胆汁酸联合检测对肝病患者的意义【摘要】目的：分析出凝血四项及总胆汁酸随肝病患者的肝功能损害程度而变化的情况，并探讨联合检测出凝血四项及总胆汁酸的意义。方法：采用Beckman LX20 全自动生化分析仪对190例肝病患者及35例健康体检者的血清进行总胆汁酸（TBA）测定，同时用Coa DATA 4001半自动血凝仪测定血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）及纤维蛋白原（FIB）水平并做相关统计学分析。结果：TBA在各型肝病中与正常对照组比较均有统计学意义（P＜0.01），PT、APTT、TT、FIB四项在急性肝炎、慢性轻度病毒性肝炎患者中与正常对照组比较差异无显著性（P＞0.05），而在慢性中、重度肝炎、活动性肝硬化及重症肝病患者中与正常对照组比较差异有显著性（P＜0.01）。结论：联合检测PT、APTT、TT、FIB及TBA能较好地反映肝功能状况并评估肝脏受损程度，可以从多方面为肝病的临床诊断提供客观准确的实验依据。

【关键词】总胆汁酸；凝血酶原时间；活化部分凝血活酶时间；凝血酶时间；纤维蛋白原

The Significance of the Determining Jointly Four Items of the Natural Bleeding and Blood Coagulation and the Total Bile Acid in Hepatopathy Patients

LONG Zhengrong

The Central Hospital of Hengyang, Hengyang, Hu’nan 421001,China

Abstract：Objective To analyze the situation that four items of the natural bleeding and blood coagulation and the total bile acid (TBA) change with hepatopathy patients，extent of damage of liver function, and to explore the significance of the determining jointly four items of the natural bleeding and blood coagulation and the TBA.Methods Serum TBA levels were detected with Beckman LX20 in 190 cases of hepatopathy patient and 35 cases of health physical examination (the normal group) person, and Plasma PT,APTT,TT and the fibrinogen (FIB) levels were detected with Coa DATA 4001 semiautomatic coagulation detector, and the results of the different groups were analyzed by relevant statistics .Results The levels of TBA had significant difference between the hepatitis group and the normal group, P <0.01. The levels of PT, APTT, TT and FIB in the acute hepatitis, chronic slight hepatitis and the normal group have not a prominent difference (P> 0.05), and those in the chronic mezzo hepatitis, serious hepatitis, hepatocirrhosis and heavy hepatic disease groups have much more prominent difference (P<0.01) than the normal group.Conclusion To measure jointly PT, APTT, TT, FIB and TBA can give the liver function state and assess the extent of damage of liver well, can offer accurate experiment basis for clinical diagnosis of hepatopathy from many aspects.

Key words：Total bile acid；Prothrombin time；Activated partial thromboplastin time；Thrombin time；Fibrinogen

肝脏是大多数凝血因子、凝血抑制剂和纤溶系统蛋白生成场所，也是许多已激活凝血因子和纤溶激活物的灭活之地，在凝血过程的各个环节中发挥重要作用；肝脏也参与胆汁酸合成、结合及胆汁酸的肠肝循环，与胆汁酸的生成和代谢有着十分密切的关系，肝病时往往导致凝血和纤溶功能的异常及血清中胆汁酸含量发生变化，为此本文对190例肝病患者及35例健康体检者的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)及TBA 进行联合检测，以探讨肝病患者随病程的进展该五项指标的变化趋势及临床意义。

1 对象和方法

1.1 检测对象

119例肝病患者均为我院2004年11月至2005年12月消化内科住院并已确诊的患者，其中男性147例，女性43例，年龄21岁~55岁，平均年龄36岁，按2000年全国病毒性肝炎防治方案的诊断标准［1］分组：急性肝炎35例，慢性轻度肝炎33例，慢性中度肝炎47例，慢性重度肝炎24例，肝炎后肝硬化29例，重症肝炎22例；正常对照组35例均为我院体检中心健康体检者，其中男性20例，女性15例，年龄27岁~59岁，平均年龄38岁，经检查各型肝炎病毒标志物均为阴性，无心、肝、肺、肾功能异常，并排除了凝血机制异常疾病及血液系统疾病。