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目的 探讨中晚期肝病患者凝血酶原时间(PT)的标准化形式。 方法 收集慢性重型肝炎患者16例,肝硬化失代偿患者50例,口服抗凝治疗4~6周患者30例。用6种不同凝血活酶国际敏感化指数(ISI)值的组织凝血活酶检测这些患者的PT、凝血酶原时间活动度(PTA)、凝血酶原时间比率(PTR)与国际标准化比率(INR)。 结果 慢性重型肝炎患者6组间PTA差异较小,平均值波动于24％~34％,上限值波动于47％~61％;而INR组间差异非常显著,平均值波动于2.55~5.13,上限值波动于4.65~12.77。单因素方差分析PPTA(0.489)>pINR(0.120)。肝硬化患者6组间PTA平均值波动于50％~59％,上限值波动于82％~90％;INR平均值波动于1.40~1.80,上限值波动于1.97~3.69。单因素方差分析PPTA(0.102)>PINR(0.01)。PTA的波动范围均小于INR。但对口服抗凝治疗的患者,INR的波动范围最小。以STA-R血凝仪的配套试剂Neoplastine所测PT值与其它5种试剂所测值进行相关分析,中晚期肝病患者PTA作为PT的表达方式时,相关性最好,而其它形式较为弥散。口服抗凝治疗患者TNR作为PT的表达方式时,相关性最好。 结论 PTA可将中晚期肝病患者PT标准化。
Objective To investigate the standardized form of prothrombin time (PT) in patients with advanced liver disease. Methods Sixteen patients with chronic severe hepatitis, 50 patients with decompensated liver cirrhosis and 30 patients with oral anticoagulation for 4-6 weeks were enrolled. The PT, prothrombin time activity (PTA), prothrombin time (PTR), and international normalized ratio (INR) of these patients were measured using six different coagulation enzymes of the International Systolic Index (ISI) ). Results There were no significant differences in PTA between the 6 groups of patients with chronic severe hepatitis, the average fluctuation ranged from 24% to 34% and the upper limit fluctuation ranged from 47% to 61%. However, the difference between the INR groups was significant with the average fluctuation ranging from 2.55 to 5.13. The upper limit fluctuates between 4.65 and 12.77. One-way ANOVA PPTA (0.489)> pINR (0.120). In patients with cirrhosis, the mean PTA fluctuated between 50% and 59% and the upper limit fluctuated between 82% and 90%. The mean INR fluctuated between 1.40 and 1.80 and the upper limit fluctuated between 1.97 and 3.69. One-way ANOVA PPTA (0.102)> PINR (0.01). The fluctuation range of PTA is less than INR. However, patients with oral anticoagulant therapy, INR fluctuations in the smallest. Correlation analysis was made between the PT values measured by Neoplastine, an ancillary reagent for STA-R coagulation analyzer, and the measured values of the other five reagents. PTA, as a PT expression pattern, showed the best correlation, while other forms were more diffuse. TNR as the expression of PT in patients with oral anticoagulant therapy, the correlation is best. Conclusions PTA can standardize PT in patients with advanced liver disease.