Coagulation dysfunction chikamu chechirwere chechiropa uye chinhu chakakosha mune dzakawanda prognostic scores.Kuchinja kwehutano hwehemostasis kunotungamirira kubuda ropa, uye matambudziko ekubuda ropa agara ari dambudziko guru rekliniki.Zvikonzero zvekubuda ropa zvinogona kukamurwa zvakaenzana kuita (1) portal hypertension, iyo isina chekuita nehemostatic mechanism;(2) mucosal kana kubaya ronda kubuda ropa, kazhinji nekupera nguva isati yakwana thrombus kana yakakwirira fibrinolysis, iyo inonzi accelerated intravascular coagulation uye fibrinolysis muchiropa chirwere Melt (AICF).Iyo nzira ye hyperfibrinolysis haina kujeka, asi inosanganisira shanduko mu intravascular coagulation uye fibrinolysis.Abnormal coagulation inoonekwa mu portal vein thrombosis (PVT) uye mesenteric vein thrombosis, pamwe nedeep vein thrombosis (DVT).Aya mamiriro ekiriniki anowanzoda anticoagulation kurapwa kana kudzivirira.Microthrombosis muchiropa inokonzerwa ne hypercoagulability inowanzokonzera chiropa atrophy.
Dzimwe shanduko dzinokosha munzira yehemostasis dzakajekeswa, dzimwe dzinowanzobuda ropa uye dzimwe dzinowanzovhara (Mufananidzo 1).Mukugadzikana kwechiropa cirrhosis, hurongwa huchagadziriswa nekuda kwezvikonzero zvinokonzerwa nedysregulated, asi chiyero ichi hachina kugadzikana uye chichakanganiswa zvakanyanya nezvimwe zvinhu, zvakadai sehuwandu hwehuwandu hweropa, chirwere chetachiona, uye kushanda kwetsvo.Thrombocytopenia inogona kunge iri iyo yakajairika pathological shanduko nekuda kwe hypersplenism uye yakaderera thrombopoietin (TPO).Platelet dysfunction yakatsanangurwa zvakare, asi shanduko idzi dzeanticoagulant dzakadzikiswa zvakanyanya nekuwedzera kwe endothelial-yakatorwa von Willebrand factor (vWF).Saizvozvowo, kuderera kwechiropa-yakagadzirwa neprocoagulant zvinhu, zvakadai sezvinhu V, VII, uye X, zvinotungamirira kunguva yakareba yeprothrombin, asi izvi zvakanyanya kuderedzwa nekuderera kwechiropa-chinobva kune anticoagulant factor (kunyanya protein C).Mukuwedzera, yakakwira endothelial-yakatorwa chinhu VIII uye yakaderera protein C inotungamira kune yakasarudzika hypercoagulable mamiriro.Shanduko idzi, dzakasanganiswa nehukama venous stasis uye endothelial kukuvara (Virchow's triad), yakatungamira mukufambira mberi kwePVT uye dzimwe nguva DVT muvarwere vane chiropa cirrhosis.Muchidimbu, nzira dzehemostatic dzechiropa chechiropa dzinowanzogadziriswa nenzira isina kugadzikana, uye kufambira mberi kwechirwere kunogona kuderedzwa mune chero nzira.
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.2019.03.07. .
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