| Background and Objective:In patients with cirrhosis, liver function is impaired, then the procoagulation factors and anticoagulation factors decrease, and the coagulation system is impaired in the ability to maintain balance and stability, which result in the formation of hypocoagulable or hypercoagulable state. Clinically, in patients with cirrhosis it is not only prone to bleeding, but also prone to venous thrombosis, and even bleeding and thrombosis coexist, which are related to the changes in the coagulation system. At present, the phenomenon of hemorrhage caused by hypocoagulable state in patients with cirrhosis has been widely paid attention to, and the phenomenon of thrombosis caused by hypercoagulable state also has gradually been taken seriously. Therefore, the detection of coagulation system in patients with cirrhosis is important to judge the patient's condition, to guide treatment and to judge prognosis. Conventional coagulation examinations have some limitations in reflecting hypocoagulable or hypercoagulable state, and can not accurately predict the risk of bleeding or thrombosis. Thromboelastography can provide information about coagulation factors, the function of platelet and fibrinogen, fibrinolysis, which determine that thromboelastography can be used as a kind of auxiliary diagnosis method for the detection of coagulation system. Thromboelastography has multiple roles such as guiding thrombolysis, anticoagulation, component blood transfusion, use of drug. In recent years, thromboelastography is widely used in guiding the component blood transfusion, monitoring and correctting hypocoagulable or hypercoagulable state, studing coagutlation mechanism and so on. At present, the application of thromboelastography in cardiovascular disease, trauma care and organ transplantation has been paid much attention, but it is still not widely used in patients with cirrhosis. The study is to investigate the role of thromboelastography in judging the risk of bleeding or thrombosis in patients with decompensated cirrhosis, and to guide clinical treatment.Method:1?Eighty patients diagnosed with decompensated cirrhosis (Child-pugh class C) not receiving drugs such as warfarin and aspirin interfered with blood clotting, without primary or secondary liver cancer and hereditary bleeding disorders were enrolled. According to the clinical manifestations, abdominal CT angiography and veins ultrasonic examination in lower limbs, cases of hemorrhage and thrombosis in patients with decompensated cirrhosis were calculated. In addition, twenty-six patients with normal liver function not receiving drugs interfered with blood clotting, without blood abnormalities and hepatobiliary disorders were enrolled. TEG, conventional coagulation examinations and blood routine tests were measured respectively. PLT, routine coagulation indexes and TEG parameters in hemorrhage group, non-hemorrhage group in patients with decompensated cirrhosis and the control group were compaired.2?Among hemorrhage group in patients with decompensated cirrhosis, PLT, conventional coagulation indexes and TEG parameters in thrombosis group and non-thrombosis group were compaired.3?Among non-hemorrhage group in patients with decompensated cirrhosis, PLT, conventional coagulation indexes and TEG parameters in thrombosis group and non-thrombosis group were compaired.Result:1?The result of conventional coagulation examinations showed that PT was significantly prolonged in both hemorrhage group and non-hemorrhage group in patients with decompensated cirrhosis compared with control group, while the level of D-D increasd, PLT and FIB decreased?P<0.05). Compared with hemorrhage group, PT and APTT were shorten, while the level of D-D decreasd, PLT and FIB increased in non-hemorrhage group(P<0.05). It indicated that hypocoagulable state were more obvious in hemorrhage group. In addition, the result of TEG showed that a angle, MA and CI were significantly lower in both hemorrhage group and non-hemorrhage group in patients with decompensated cirrhosis compared with control group, while K value increased and R value decreased. Compared with non-hemorrhage group, a angle, MA and CI were lower, hypocoagulable state were more obvious in hemorrhage group. There were no significant difference in LY30 in each group(P>0.05).2?Among hemorrhage group in patients with decompensated cirrhosis, the result of TEG showed that a angle was higher in thrombosis group than those in non-thrombosis group(P<0.05). There were no significant difference in other TEG parameters such as R value, K value, MA, CI and conventional coagulation indexes such as PLT?PT?APTT?FIB?D-D in both two groups(P>0.05).3?Among non-hemorrhage group in patients with decompensated cirrhosis, the result of conventional coagulation examinations showed that PLT was higher in thrombosis group than those in non-thrombosis group(P<0.05). There were no significant difference in other conventional coagulation indexes such as PT?APTT?FIB?D-D and TEG parameters in both two groups(P>0.05).Conclusion:TEG can be used as clinical indexs to judge coagulation states in patients with decompensated cirrhosis. In study, the result of TEG shows that function of platelet and fibrinogen decrease in patients with decompensated cirrhosis (K value increase, ? angle and MA decrease), which is more obvious in hemorrhage group. Therefore, TEG can predict the high risk of bleeding and guide clinical treatment such as component blood transfusion. It is one of means to reduce the risk of bleeding. In addition, TEG can reflect high clotting factor in patients with decompensated cirrhosis (R value decrease), but TEG does not accurately predict the risk of thrombosis in patients with decompensated cirrhosis. The study has limitations because of short research time and few research objects. So, large scale clinical research needs to be further explored. |
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