Характер изменений системы гемостаза у больных циррозом печени

Abstract

Нами исследована про- и антикоагулянтная системы в динамике у больных с компенсированным и осложненным течением заболевания. Показано наличие тромбофилии у больных с компенсированным течением цирроза печени, что может быть одним из патогенетических факторов развития осложнений, и синдрома диссеминированного внутрисосудистого свертывания у больных с декомпенсированным циррозом, что является следствием тромбофилии и причиной геморрагического синдрома. Since there were doubts as to the causes of hemorrhagic complications in liver cirrhosis it is actual a topical study both pro- and anticoagulant hemostasis. Aim. To evaluate the hemostatic system in patients with liver cirrhosis. Material and methods. 190 patients with cirrhosis were under examination: 123 have gastrointestinal bleeding, 67 – refractory ascites. 84 patients died during examination. The duration of examination was from 2–3 weeks to 2.5–3 years. Estimation of procoagulant unit include determining the number of platelets, prothrombin index, activated partial thromboplastin time, blood-coagulation factor F VIII, fibrinogen levels, “B” and D-dimer fibrinogen. Anticoagulant system was evaluated by activity of coagulation inhibitor of protein C. Results. In 71.5 % of discharged patients with bleeding and 60.0% of deaths, the activity of blood-coagulation factor F VIII exceeded normal levels. Increased activity of F VIII in patients with ascites was at 66.7 % and 92.0 %, respectively. In the dynamics of the percentage of patients with elevated F VIII in all groups increased, reaching 85.8 %–94.0 % (p<0.01). The activity of protein C anticoagulant factor for 71.4 %–88.0 % of patients, which hospitalized with complications of LC, was reduced, accounting for less than 70 %. Low activity of protein C remained in dynamics such as those discharged and deceased patients, 68.0 % and 75.0 %, respectively, at DH and 90.0 % –4.0 % – at ascites, (p <0.01). Confirmation of the presence of thrombophilia in cirrhotic patients is to determine the level of D-dimer. At 75.0 %–97.0 % of patients hospitalized with complications of the LC, the content of D-dimer in serum at admission was 5–8 times higher among patients subsequently discharged and 8–12 times among the dead, not decreasing over time (p <0,01).