Coagulation dysfunction yog ib feem ntawm kab mob siab thiab yog ib qho tseem ceeb ntawm feem ntau cov qhab nia prognostic.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.Qhov ua rau los ntshav tuaj yeem faib ua roughly faib ua (1) portal hypertension, uas tsis muaj dab tsi cuam tshuam nrog hemostatic mechanism;(2) mucosal los yog puncture qhov txhab los ntshav, feem ntau nrog ntxov ntxov dissolution ntawm thrombus los yog siab fibrinolysis, uas yog hu ua accelerated intravascular coagulation thiab fibrinolysis nyob rau hauv daim siab mob Melt (AICF).Cov txheej txheem ntawm hyperfibrinolysis tsis meej, tab sis nws cuam tshuam nrog kev hloov pauv hauv intravascular coagulation thiab fibrinolysis.Kev coagulation txawv txav yog pom nyob rau hauv portal vein thrombosis (PVT) thiab mesenteric vein thrombosis, nrog rau cov hlab ntsha sib sib zog nqus thrombosis (DVT).Cov mob no feem ntau xav tau kev kho mob anticoagulation lossis tiv thaiv.Microthrombosis nyob rau hauv daim siab tshwm sim los ntawm hypercoagulability feem ntau ua rau daim siab atrophy.
Qee qhov kev hloov pauv tseem ceeb hauv txoj hauv kev hemostasis tau qhia meej, qee qhov zoo li los ntshav thiab lwm tus zoo li txhaws (Daim duab 1).Nyob rau hauv daim siab mob cirrhosis ruaj khov, lub kaw lus yuav rov ua kom zoo dua qub vim muaj cov yam ntxwv tsis zoo, tab sis qhov nyiaj tshuav no tsis ruaj khov thiab yuav cuam tshuam rau lwm yam, xws li cov ntshav ntim, kab mob hauv lub cev, thiab lub raum ua haujlwm.Thrombocytopenia tej zaum yuav yog qhov kev hloov pauv ntau tshaj plaws vim yog hypersplenism thiab txo qis thrombopoietin (TPO).Platelet dysfunction kuj tau piav qhia, tab sis cov kev hloov pauv tshuaj tiv thaiv kab mob no tau raug cuam tshuam los ntawm kev nce hauv endothelial-derived von Willebrand factor (vWF).Ib yam li ntawd, qhov txo qis hauv daim siab tau txais los ntawm procoagulant yam, xws li yam V, VII, thiab X, ua rau lub sij hawm prothrombin ntev, tab sis qhov no cuam tshuam loj heev los ntawm kev txo qis hauv daim siab los ntawm cov tshuaj tiv thaiv coagulant (tshwj xeeb tshaj yog cov protein C).Tsis tas li ntawd, nce endothelial-derived yam VIII thiab cov protein C tsawg ua rau muaj lub xeev hypercoagulable.Cov kev hloov no, ua ke nrog cov txheeb ze venous stasis thiab endothelial kev puas tsuaj (Virchow's triad), ua rau muaj kev sib koom ua ke ntawm PVT thiab qee zaus DVT hauv cov neeg mob siab cirrhosis.Nyob rau hauv luv luv, txoj kev hemostatic ntawm daim siab cirrhosis feem ntau rebalanced nyob rau hauv ib tug tsis ruaj khov yam, thiab kev loj hlob ntawm tus kab mob yuav tilted nyob rau hauv txhua txoj kev.
Reference: O'Leary JG, Greenberg CS, Patton HM, Caldwell SH.AGA Clinical Practice Update: Coagulation inCirrhosis.Gastroenterology.2019,157(1):34-43.e1.doi:10.1053/j.gastro.2019.03.070 .
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