Kev ua haujlwm tsis zoo ntawm cov ntshav txhaws yog ib feem ntawm kab mob siab thiab yog qhov tseem ceeb hauv feem ntau cov qhab nia kwv yees. Kev hloov pauv ntawm qhov sib npaug ntawm hemostasis ua rau los ntshav, thiab cov teeb meem los ntshav yeej ib txwm yog qhov teeb meem loj hauv kev kho mob. Cov ua rau los ntshav tuaj yeem faib ua (1) portal hypertension, uas tsis muaj dab tsi ua rau lub tshuab hemostatic; (2) mucosal lossis puncture wound los ntshav, feem ntau nrog kev yaj ua ntej ntawm thrombus lossis fibrinolysis siab, uas hu ua accelerated intravascular coagulation thiab fibrinolysis hauv kab mob siab Melt (AICF). Lub tshuab ntawm hyperfibrinolysis tsis meej, tab sis nws cuam tshuam nrog kev hloov pauv hauv intravascular coagulation thiab fibrinolysis. Kev coagulation tsis zoo pom hauv portal vein thrombosis (PVT) thiab mesenteric vein thrombosis, nrog rau deep vein thrombosis (DVT). Cov mob hauv tsev kho mob no feem ntau xav tau kev kho mob anticoagulation lossis kev tiv thaiv. Microthrombosis hauv lub siab los ntawm hypercoagulability feem ntau ua rau lub siab atrophy.
Muaj qee qhov kev hloov pauv tseem ceeb hauv txoj kev hemostasis tau piav qhia meej lawm, qee qhov feem ntau yuav los ntshav thiab lwm qhov feem ntau yuav txhaws (Daim Duab 1). Hauv daim siab cirrhosis ruaj khov, lub cev yuav rov qab sib npaug vim yog cov yam tsis zoo, tab sis qhov sib npaug no tsis ruaj khov thiab yuav raug cuam tshuam los ntawm lwm yam, xws li qhov ntsuas ntshav, kev kis kab mob hauv lub cev, thiab kev ua haujlwm ntawm lub raum. Thrombocytopenia tej zaum yog qhov kev hloov pauv pathological feem ntau vim yog hypersplenism thiab txo qis thrombopoietin (TPO). Platelet dysfunction kuj tau piav qhia, tab sis cov kev hloov pauv anticoagulant no tau raug cuam tshuam los ntawm kev nce ntxiv ntawm endothelial-derived von Willebrand factor (vWF). Ib yam li ntawd, kev txo qis ntawm cov yam ntxwv procoagulant los ntawm lub siab, xws li cov yam ntxwv V, VII, thiab X, ua rau lub sijhawm prothrombin ntev, tab sis qhov no tau raug cuam tshuam los ntawm kev txo qis ntawm cov yam ntxwv anticoagulant los ntawm lub siab (tshwj xeeb tshaj yog protein C). Tsis tas li ntawd, endothelial-derived factor VIII siab thiab protein C qis ua rau muaj qhov xwm txheej hypercoagulable. Cov kev hloov pauv no, ua ke nrog cov leeg ntshav tsis txav thiab kev puas tsuaj ntawm cov hlab ntsha hauv lub cev (Virchow's triad), ua rau muaj kev nce qib ntawm PVT thiab qee zaum DVT hauv cov neeg mob uas muaj kab mob siab cirrhosis. Hauv ntej, txoj kev hemostatic ntawm kab mob siab cirrhosis feem ntau rov qab sib npaug hauv txoj kev tsis ruaj khov, thiab kev nce qib ntawm tus kab mob tuaj yeem tig mus rau txhua qhov kev taw qhia.
Siv: O'Leary JG, Greenberg CS, Patton HM, Caldwell SH.AGA Kev Kho Mob Hloov Tshiab: Coagulation inCirrhosis.Gastroenterology.2019,157(1):34-43.e1.doi:10.1053/j.gastro.2019.03.070.
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