| Objective：Esophageal and gastric varices bleeding (EGVB) is one of themost common and serious complications of liver cirrhosis and portalhypertension, which is also the leading cause of death in the patients. With thedevelopment of endoscopic technology and equipments, endoscopic treatmenthas improved significantly the successful rate of cure, which has becomegradually the main treat method of esophageal and gastric varices. But thereare also many complications, such as postoperative fever, pain, ulceration,bleeding, ectopic embolization, portal vein and mesenteric venous thrombosis,especially complicated with thrombosis increased gradually. A complexbalance between endogenous procoagulant and anticoagulant factors exists inpatients with liver cirrhosis. As disease progresses profound changes in thehaemostatic system occur including decreased circulating levels ofcoagulation factors and inhibitors, reduced levels of fibrinolytic proteins aswell as thrombocytopenia, so patients often present with bleeding orthrombosis. Tissue factor pathway inhibitor (TFPI) is a proteinase inhibitor,and is synthesized by the microvascular endothelial cells. The primarilybiological effects of TFPI included anticoagulant, anti-inflammatory and ect.The purpose of this study was to evaluate TFPI and coagulation, fibrinolysisindexes (PT, PA, INR, APTT, TT, Fib, D-dimer) of the liver cirrhosis patientswith esophageal and gastric varice bleeding after endoscopic treatment,investigate whether endoscopic treatment impact coagulation, fibrinolysissystem or related with hemorrhage or thrombosis. In order to provide potentialstrategy for preventing the occurrence of hemorrhage and thrombosis afterendoscopic treatment.Methods：The subjects were hospitalized liver cirrhosis patients with EGVB in Department of Gastroenterology，the Second Hospital of HeBeiMedical University from May2011to December2011.26of44cases weremale and18were female. Age ranged from24to77years old. The mean agewas (53.28±11.06) years. Liver cirrhosis of hepatitis B virus infection were30cases, hepatitis C virus infection were2cases, hepatitis B and hepatitis C virusinfection was1case,2cases of alcoholic cirrhosis, alcohol and virus infectionwere3cases, cavernous transformation of portal vein were3cases, primarybiliary liver cirrhosis was1case, autoimmune cirrhosis was1case,cryptogenic cirrhosis was1case. According to Child-Pugh classificationstandards, grade A included30cases, grade B included13cases, and grade Cincluded1case. Child-Pugh C only1case, merged Child-Pugh C intoChild-Pugh B. According to different therapeutic methods devided intoesophageal varices ligation (EVL) group, endoscopic injection sclerotherapy(EIS) group, α–cyanoacrylate injection group and combined treament group.TFPI, PT, PA, INR, APTT, TT, Fib, D-dimer were all tested. All patients werefollowed up at preoperative,1day and7days after endoscopic teatment. Theaim was to observe the above indexes in different groups, time andChild-Pugh cassifications after endoscopic treament.Data were presented as means±standard deviation. Repeated measurewas applied to examine the differences between the groups and time. Aprobability of less than0.05was considered significantly.Results1The changes of TFPI before and after endoscopic treamentThe level of plasma TFPI decreased significantly in patients ofChild-Pugh B+C preoperative and7d after endoscopic treatment,(22.26±5.32ng/mlvs.27.16±8.77ng/ml, P＜0.05;22.36±7.04ng/mlvs.28.55±8.84ng/ml, P＜0.05). There was no significant difference among the level of plasma TFPIin the44liver cirrhosis patients at preoperative,1d and7d after endoscopictreatment. In Child-Pugh A and Child-Pugh B+C, the level of plasma TFPIshowed no significant difference at preoperative,1d and7d after endoscopictreatment. In different endoscopic treament groups, the level of plasma TFPI had no significant difference (P=0.128). Compared1d and7d after endoscopictreatment with preoperative (0d) in different endoscopic treatment groups, thelevel of plasma TFPI showed no significant difference (P=0.620).2The changes of coagulation and fibrinolysis indexesCompared with Child-Pugh A, in Child-Pugh B+C PA and Fib decreased,the levels of PT, INR and plasma D-dimer increased (P＜0.05), they hadstatistical difference, While APTT, TT had no significant difference (P>0.05).Compared1d and7d after endoscopic treatment with preoperative (0d),the levels of PT, PA, INR, APTT, Fib and TT had no statistical differences, theP values were0.059,0.170,0.317,0.114,0.717and0.317. The level ofplasma D-dimer increased significantly in patients at1d after endoscopictreatment,(0.76±0.41mg/Lvs.0.68±0.37mg/L), there was statisticaldifference (P=0.003), there was no significant difference between7d and0d(P=0.922).Compared1d and7d after endoscopic treatment with preoperative (0d) inpatients with Child-Pugh A, the levels of PT, PA, INR, APTT, Fib and TTwere no statistical differences, the P values were0.180,0.309,0.112,0.582,0.298and0.327. The level of plasma D-dimer increased significantly inpatients at1d after endoscopic treatment,(0.66±0.38mg/Lvs.0.56±0.33mg/L),there was statistical difference (P=0.003), there was no significant differencebetween7d and0d (P=0.233).Compared1d and7d after endoscopic treatment with preoperative (0d) inpatients with Child-Pugh B+C, the levels of plasma PT, PA, INR, APTT, Fib,TT and D-dimer were no statistical difference, the P values were0.318,0.529,0.557,0.051,0.279,0.099and0.167.Compared1d and7d after endoscopic treatment with preoperative (0d) indifferent endoscopic treatment groups (EVL, EIS, α–cyanoacrylate injectiongroup and combined treament group) the levels of PT, PA, INR, APTT, Fiband TT were no statistical difference, P values were0.256,0.989,0.154,0.144,0.409and0.053. There was no significant difference in different endoscopic treatment groups. The level of plasma D-dimer increased significantly inpatients at1d after endoscopic treatment, there was statistical difference(P=0.002), there was no significant difference between7d and0d (P=0.987).In different endoscopic treatment groups, there was no significant difference(P=0.405)ConclusionThe levels of plasma TFPI, coagulation and fibrinolysis indexes (PT,PA, INR, Fib and D-dimer) can reflect the severity of illness in patients withliver cirrhosis. The level of plasma D-dimer increased significantly in patientsat1d after endoscopic treatment, there was no significant difference between7d and0d. Endoscopic treatment had no obvious effect on the plasma TFPI,coagulation and fibrinolysis indexes. |
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