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目的探讨老年肝硬化患者血小板参数、凝血功能与Child-Pugh分级的相关性,为老年肝硬化患者的消化道出血的判断及评估提供参考。方法收集老年肝硬化患者159例,A级57例,B级59例,C级43例。根据住院期间是否发生消化道出血将患者分为出血组43例和未出血组116例,比较各组血小板参数及凝血功能指标的变化情况。结果肝硬化各分级组PLT、Fbg水平明显低于对照组,且随着分级的增加而逐渐降低;平均血小板体积(MPV)、血小板宽度(PDW)、大血小板比率(P-LCR)及凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)明显高于对照组,且随着分级的增加而逐渐升高(P<0.05)。出血组和未出血组PLT均比对照组减少(P<0.05),MPV、PDW、P-LCR明显增高(P<0.05);出血组血小板计数(PLT)较未出血组减少明显(P<0.05);出血组MPV、PDW、P-LCR较未出血组明显增高(P<0.05),出血组和未出血组PT、APTT、TT均比对照组延长(P<0.05);出血组PT、APTT、TT较未出血组延长(P<0.05);血组纤维蛋白原(Fbg)较正常组、未出血组明显降低(P<0.05),正常组和未出血组Fbg比较差异无统计学意义(P>0.05)。结论血小板、凝血功能与肝硬化Child-Pugh分级存在较明显的正相关性,两者在肝硬化患者消化道出血中发挥着重要作用,动态监测血小板参数及凝血功能指标的变化,对预判肝硬化患者的出血倾向有着较积极的作用。
Objective To investigate the correlation between platelet parameters, coagulation function and Child-Pugh classification in elderly patients with cirrhosis, and to provide a reference for the judgment and assessment of gastrointestinal bleeding in elderly patients with liver cirrhosis. Methods A total of 159 elderly patients with cirrhosis were enrolled. A grade was 57, grade B was 59, grade C was 43. Patients were divided into hemorrhage group (n = 43) and non-hemorrhage group (n = 116) according to whether there was gastrointestinal bleeding during hospitalization. The changes of platelet parameters and coagulation indexes in each group were compared. Results The levels of PLT and Fbg in each grading group were significantly lower than those in control group, and gradually decreased with the grading. The mean platelet volume (MPV), platelet width (PDW), P-LCR and thrombin The PT, APTT and TT were significantly higher than those in the control group, and gradually increased with the increase of grading (P <0.05). PLT in both hemorrhagic and non-hemorrhagic groups was significantly lower than that in control group (P <0.05), and MPV, PDW and P-LCR were significantly increased (P <0.05); platelet count (PLT) (P <0.05). The levels of PT, APTT and TT in the hemorrhage and non-hemorrhage groups were longer than those in the control group (P <0.05). The levels of PT and APTT in the hemorrhage group were significantly higher than those in the control group (P <0.05). Compared with normal group and non-bleeding group, fibrinogen (Fbg) in blood group was significantly lower (P <0.05), and there was no significant difference in Fbg between normal group and non-hemorrhage group P> 0.05). Conclusions There is a significant positive correlation between platelet and coagulation function and Child-Pugh classification of cirrhosis. Both of them play an important role in gastrointestinal bleeding in patients with cirrhosis. Dynamic changes of platelet parameters and coagulation parameters are monitored. Bleeding tendency of patients with hardening has a more positive effect.