血栓弹力图对肝病患者凝血功能的评估及输血指导研究进展(1)
摘 要：肝病患者经常因为自身凝血因子合成受阻，导致凝血功能失调，进而延长血浆凝血时间，增加出血风险，临床上主要通过输注冰冻血浆、冷沉淀及血小板等纠正其凝血功能障碍。然而，输血时间及输血成分的选择目前尚未形成统一定论。若不及时输血，则有面临大出血的风险；而不合理输血，势必会浪费血液资源、增加通过血液制品传播疾病的危害性。血栓弹力图作为近几年发展迅速的一种便捷、即时的评估全血凝血功能的检测方法，通过观察全血从形成血栓到血栓溶解全过程的动态变化，综合有效地评估肝病患者凝血功能，并科学、合理地指导临床用血。本文旨在针对TEG用于评估肝病患者凝血功能和指导个体化用血两方面作一综述，以期为临床工作提供借鉴与参考。
关键词：血栓弹力图；肝病；凝血功能；输血指导
中图分类号：R457.1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.08.014
文章编号：1006-1959(2018)08-0042-04
, http://www.100md.com
Evaluation of Blood Coagulation in Patients with Liver Disease by Thromboelastogram and Research Progress on Blood Transfusion
LIU Fang-rui，YU Ze-bo
(Department of Blood Transfusion，The First Affiliated Hospital，Chongqing Medical University，Chongqing 400016，China)
Abstract：Patients with liver disease are often blocked by their own clotting factor synthesis，leading to coagulation dysfunction， thereby prolonging plasma clotting time and increasing the risk of bleeding.Clinically，coagulation dysfunction is mainly corrected by infusion of frozen plasma，cryoprecipitate，and platelets.However，the choice of blood transfusion time and blood transfusion components has not yet reached a consensus.If blood transfusions are not given in time，there is a risk of major bleeding； unreasonable blood transfusions are bound to waste blood resources and increase the danger of spreading diseases through blood products.The thrombo-elasticity chart has been rapidly developed in recent years as a convenient and timely method for the assessment of coagulation function in whole blood.By observing the dynamic changes in the whole process of blood formation from thrombosis to thrombolysis， comprehensively and effectively evaluate coagulation function in patients with liver disease.And scientifically and reasonably guide clinical blood use.This article aims to review the two aspects of TEG for assessing coagulation function in patients with liver disease and guiding individualized use of blood in order to provide reference for clinical work.
, 百拇医药
Key words：Thromboelastogram；Liver disease；Coagulation；Transfusion guidance
肝脏因其自身特殊的合成-降解促凝和抗凝物质的功能，成为人体凝血系统中最重要的脏器。而肝病患者因为肝细胞的损害，致使凝血功能紊乱，临床上不仅可能诱发出血，同时还可能导致血栓形成。传统凝血功能检查仍存在局限性，严重干扰了医生对肝病患者的治疗。而血栓弹力图(thrombelastography，TEG)的运用能够有效评估肝病患者的凝血全貌，为临床提供客观、全面的数据。本综述将从肝病患者的凝血特点入手，回顾TEG在肝病患者凝血功能评估和指导临床用血方面进行阐释。
1肝病患者的凝血特点
1.1肝病患者的凝血机制 肝臟主要通过合成大量凝血因子(除Ⅷ、Ⅸ因子外)，清除血液中过多的抗凝物质，从而维持人体内凝血-抗凝功能的稳态。对于肝病患者而言，由于肝细胞不同程度的损害，主要通过以下三个方面干扰人体内凝血和抗凝系统的平衡：①蛋白质的合成降低，使凝血因子(如Ⅱ、Ⅴ、Ⅺ、Ⅻ)分泌不足，进而导致获得性凝血功能紊乱；②相关维生素K依赖性凝血因子(Ⅱ、Ⅶ、Ⅸ、Ⅹ)前体无法获取充足的维生素K，致使其无法活化形成有效的凝血因子，加重凝血功能障碍；③肝素酶的合成降低，诱导肝素失去活性，引发血液中类肝素等抗凝物质蓄积，使得血液常处于低凝状态。而当肝损害加重，出现脾亢或DIC时，则会从增加血小板消耗，纤溶功能紊乱等多方面破坏体内凝血功能，增加患者出血风险。最终，上述因素均可引起传统凝血功能检查指标的延长[1，2]。, http://www.100md.com(刘方睿 余泽波)
关键词：血栓弹力图；肝病；凝血功能；输血指导
中图分类号：R457.1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.08.014
文章编号：1006-1959(2018)08-0042-04
, http://www.100md.com
Evaluation of Blood Coagulation in Patients with Liver Disease by Thromboelastogram and Research Progress on Blood Transfusion
LIU Fang-rui，YU Ze-bo
(Department of Blood Transfusion，The First Affiliated Hospital，Chongqing Medical University，Chongqing 400016，China)
Abstract：Patients with liver disease are often blocked by their own clotting factor synthesis，leading to coagulation dysfunction， thereby prolonging plasma clotting time and increasing the risk of bleeding.Clinically，coagulation dysfunction is mainly corrected by infusion of frozen plasma，cryoprecipitate，and platelets.However，the choice of blood transfusion time and blood transfusion components has not yet reached a consensus.If blood transfusions are not given in time，there is a risk of major bleeding； unreasonable blood transfusions are bound to waste blood resources and increase the danger of spreading diseases through blood products.The thrombo-elasticity chart has been rapidly developed in recent years as a convenient and timely method for the assessment of coagulation function in whole blood.By observing the dynamic changes in the whole process of blood formation from thrombosis to thrombolysis， comprehensively and effectively evaluate coagulation function in patients with liver disease.And scientifically and reasonably guide clinical blood use.This article aims to review the two aspects of TEG for assessing coagulation function in patients with liver disease and guiding individualized use of blood in order to provide reference for clinical work.
, 百拇医药
Key words：Thromboelastogram；Liver disease；Coagulation；Transfusion guidance
肝脏因其自身特殊的合成-降解促凝和抗凝物质的功能，成为人体凝血系统中最重要的脏器。而肝病患者因为肝细胞的损害，致使凝血功能紊乱，临床上不仅可能诱发出血，同时还可能导致血栓形成。传统凝血功能检查仍存在局限性，严重干扰了医生对肝病患者的治疗。而血栓弹力图(thrombelastography，TEG)的运用能够有效评估肝病患者的凝血全貌，为临床提供客观、全面的数据。本综述将从肝病患者的凝血特点入手，回顾TEG在肝病患者凝血功能评估和指导临床用血方面进行阐释。
1肝病患者的凝血特点
1.1肝病患者的凝血机制 肝臟主要通过合成大量凝血因子(除Ⅷ、Ⅸ因子外)，清除血液中过多的抗凝物质，从而维持人体内凝血-抗凝功能的稳态。对于肝病患者而言，由于肝细胞不同程度的损害，主要通过以下三个方面干扰人体内凝血和抗凝系统的平衡：①蛋白质的合成降低，使凝血因子(如Ⅱ、Ⅴ、Ⅺ、Ⅻ)分泌不足，进而导致获得性凝血功能紊乱；②相关维生素K依赖性凝血因子(Ⅱ、Ⅶ、Ⅸ、Ⅹ)前体无法获取充足的维生素K，致使其无法活化形成有效的凝血因子，加重凝血功能障碍；③肝素酶的合成降低，诱导肝素失去活性，引发血液中类肝素等抗凝物质蓄积，使得血液常处于低凝状态。而当肝损害加重，出现脾亢或DIC时，则会从增加血小板消耗，纤溶功能紊乱等多方面破坏体内凝血功能，增加患者出血风险。最终，上述因素均可引起传统凝血功能检查指标的延长[1，2]。, http://www.100md.com(刘方睿 余泽波)