The coagulation process is a waterfall-type protein enzymatic hydrolysis process involving about 20 substances, most of which are plasma glycoproteins synthesized by the liver, so the liver plays a very important role in the hemostasis process in the body. Bleeding is a common clinical symptom of liver disease (liver disease), especially severe patients, and one of the important causes of death.
The liver is a place for synthesizing a variety of coagulation factors, and can synthesize and inactivate fibrin lysates and antifibrinolytic substances, and play a regulatory role in maintaining the dynamic balance of the coagulation and anticoagulation system. The detection of blood coagulation indexes in patients with hepatitis B showed that there was no significant difference in PTAPTT in patients with chronic hepatitis B compared with the normal control group (P>0.05), but there was a significant difference in FIB (P<0.05). There were significant differences in PT, APTT, and FIB between the severe hepatitis B group and the normal control group (P<005P<0.01), which proved that the severity of hepatitis B was positively correlated with the reduction of blood coagulation factor levels.
Analysis of the reasons for the above results:
1. Except for factor IV (Ca*) and cytoplasm, other plasma coagulation factors are synthesized in the liver; anticoagulation factors (coagulation inhibitors) such as ATIPC, 2-MaI-AT, etc. are also synthesized by the liver. cellular synthesis. When the liver cells are damaged or necrotic to different degrees, the ability of the liver to synthesize coagulation factors and anti-coagulation factors is reduced, and the plasma levels of these factors are also reduced, resulting in obstacles to the coagulation mechanism. PT is a screening test of extrinsic coagulation system, which can reflect the level, activity and function of coagulation factor IV V X in plasma. The reduction of the above factors or the changes in their activities and functions have become one of the reasons for the prolonged PT in patients with post-hepatitis B cirrhosis and severe hepatitis B. Therefore, PT is commonly used clinically to reflect the synthesis of coagulation factors in the liver.
2. On the other hand, with the damage of liver cells and liver failure in hepatitis B patients, the level of plasmin in plasma increases at this time. Plasmin can not only hydrolyze a large amount of fibrin, fibrinogen and many coagulation factors such as factor training, XXX, VVII, Ⅱ, etc., but also consume a large amount of anti-coagulation factors such as ATⅢPC and so on. Therefore, with the deepening of the disease, the APTT prolonged and the FIB decreased significantly in hepatitis B patients.
In conclusion, the detection of coagulation indexes such as PTAPTTFIB has very important clinical significance for judging the condition of patients with chronic hepatitis B, and is a sensitive and reliable detection index.