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凝血检验没有那么简单，报告应该这么解读

2018-05-09 董卫国 检验连线

凝血检验报告解读医学知识
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出血和凝血问题与多种疾病相关，但是约90％的出凝血问题可以由血栓与止血实验室给予诊断。目前较常规的检测项目是凝血项，这些简单的检查，要是理解到位，作用不可小觑。


作者：湖北省中西医结合医院医学检验科临检室  董卫国

出血和凝血问题与多种疾病相关，但是约90％的出凝血问题可以由血栓与止血实验室给予诊断。目前较常规的检测项目是凝血项，这些简单的检查，要是理解到位，作用不可小觑。

凝血4项检查包括：凝血酶原时间(prothrombin time，PT)、活化部分凝血活酶时间(activated partial thromboplastintime，APTT)、凝血酶时间(thrombin time，TT)、纤维蛋白原(fibrinogen，FIB)

1凝血酶原时间(prothrombin time，PT)

PT正常值 11-14秒，主要反映外源性凝血系统状况，延长见于先天性凝血因子ⅡⅤⅦⅩ缺乏及纤维蛋白原缺乏，后天凝血因子缺乏主要见于维生素K缺乏、严重的肝脏疾病、纤溶亢进、DIC、口服抗凝剂等；缩短见于血液高凝状态和血栓性疾病等。

凝血酶原时间是监测口服抗凝剂的常用指标，在ISI介于2.2-2.6时,凝血酶原时间比值在1.5-2.0 INR在3.0-4.5用药为合理和安全。世界卫生组织（WHO）规定应用口服抗凝剂时INR的允许范围：非髋部外科手术前1.5-2.5;髋部外科手术前2.0-3.0;深静脉血栓形成2.0-3.0;治疗肺梗塞2.0-4.0;预防动脉血栓形成3.0-4.0;人工瓣膜手术3.0-4.0。

2活化部分凝血活酶时间(activated partial thromboplastintime，APTT)

APTT正常值25-40s,主要反映内源性凝血系统状况，常用于监测肝素用量。增高见于血浆因子Ⅷ、因子Ⅸ和因子XI水平减低：如血友病A、血友病B及因子XI缺乏症；降低见于高凝状态：如促凝物质进入血液及凝血因子的活性增高等情况。

3凝血酶时间(thrombin time，TT)

TT正常值12-16秒，凝血酶时间延长：见于肝素增多或类肝素抗凝物质存在、如SLE、肝病、肾病等，低（无）纤维蛋白血症、异常纤维蛋白原血症、纤维蛋白原降解产物（FDP）增多、如DIC、原发性纤溶等。凝血酶时间缩短：见于血标本有微小凝块或钙离子存在时。

4纤维蛋白原(fibrinogen，FIB)

FIB正常值 2-4 g/L主要反映纤维蛋白原的含量。增高见于急性心肌梗死 减低见于DIC消耗性低凝溶解期、原发性纤溶症、重症肝炎、肝硬化。主要反映纤维蛋白原转为纤维蛋白的时间。

凝血四项检查结果解读

1 PT、APTT都缩短：PT、APTT缩短，FIB升高：表明患者处于高凝血功能状态，具有血栓形成高发风险。可结合高凝状态监测D二聚体等指标。临床上，建议医生防范血栓风险。

2 PT、APTT都延长：FIB水平低、患者使用将纤维蛋白药物均可导致PT、APTT延长。肝病、弥漫性血管内溶血（DIC）以及抗凝治疗也会引起两者延长。也可能是凝血过程中共同通路的凝血因子异常，如凝血因子V、X异常，以及凝血酶原(Ⅱ因子)、纤维蛋白原(I因子)异常。

3 PT延长为主，AFTT基本正常：PT延长，在临床最常见的是双香豆素药物抗凝，如华法林、误服鼠药(成分为华法林)及维生素K缺乏的患者。华法林等药物抑制维生素K依赖的凝血因子(Ⅱ、Ⅶ、Ⅸ、X)的羧化，从而起到抗凝血作用，常用剂量将国际标准化比率(international normalized ratio，INR)调整在2-3之间。PT延长，较少见的情况还有凝血因子Ⅶ的缺陷。

4 APTT延长为主，PT基本正常：APTT延长，临床常见的是肝素抗凝治疗，低分子量肝素，口服Xa因子抑制剂，口服凝血酶抑制剂也会引起延长。 如未使用抗凝药物，应做APTT纠正实验，将患者血浆与正常血浆1:1混合后做APTT纠正实验。若APTT能纠正，意味着凝血因子的缺乏，如血管性血友病因子(von willebrand factor，vWF)、内源性凝血因子Ⅷ、Ⅸ、Ⅺ、Ⅻ异常；如APTT不能纠正，意味着存在凝血抑制物，如凝血因子抑制物、狼疮抗凝物质等。 

APTT纠正实验的原理在于，只要存在30％的凝血因子，APTT就可以达到正常，1：1混合实验提供了50％的凝血因子，所以因子缺乏可纠正，如存在抑制物就不能纠正。从而可以鉴别是因子缺乏，还是存在凝血抑制，有效选择下一步确认实验。如：APTT延长，不能1：1纠正，结合患者伴血栓形成，推荐做抗磷脂综合征检测。

当然出血和凝血是一个复杂的过程，凝血四项只是反应了凝血瀑布级联反应中的某一个部分,即内源性或外源性凝血途径,或纤维蛋白溶解部分的情况，我们要全面了解必须综合D二聚体、FDP、凝血因子检测以及血栓弹力图等结果。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1447026, encodeId=899c144e026f5, content=<a href='/topic/show?id=549489135c5' target=_blank style='color:#2F92EE;'>#血检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89135, encryptionId=549489135c5, topicName=血检)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cc1f5300484, createdName=Luyuxie_11, createdTime=Fri May 11 12:58:00 CST 2018, time=2018-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313743, encodeId=fb50313e4332, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Thu May 10 08:03:59 CST 2018, time=2018-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313628, encodeId=e80e3136281c, content=学习了.有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73441710184, createdName=明崖, createdTime=Wed May 09 23:42:41 CST 2018, time=2018-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313617, encodeId=02f331361eeb, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Wed May 09 23:26:59 CST 2018, time=2018-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313595, encodeId=a354313595ef, content=出血和凝血问题与多种疾病相关.但是约90%的出凝血问题可以由血栓与止血实验室给予诊断.目前较常规的检测项目是凝血项.这些简单的检查.要是理解到位.作用不可小觑., beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Wed May 09 22:51:43 CST 2018, time=2018-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313591, encodeId=d04b313591db, content=不错的文章值得拥有, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Wed May 09 22:43:57 CST 2018, time=2018-05-09, status=1, ipAttribution=)]
    2018-05-11 Luyuxie_11

    #血检#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1447026, encodeId=899c144e026f5, content=<a href='/topic/show?id=549489135c5' target=_blank style='color:#2F92EE;'>#血检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89135, encryptionId=549489135c5, topicName=血检)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cc1f5300484, createdName=Luyuxie_11, createdTime=Fri May 11 12:58:00 CST 2018, time=2018-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313743, encodeId=fb50313e4332, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Thu May 10 08:03:59 CST 2018, time=2018-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313628, encodeId=e80e3136281c, content=学习了.有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73441710184, createdName=明崖, createdTime=Wed May 09 23:42:41 CST 2018, time=2018-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313617, encodeId=02f331361eeb, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Wed May 09 23:26:59 CST 2018, time=2018-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313595, encodeId=a354313595ef, content=出血和凝血问题与多种疾病相关.但是约90%的出凝血问题可以由血栓与止血实验室给予诊断.目前较常规的检测项目是凝血项.这些简单的检查.要是理解到位.作用不可小觑., beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Wed May 09 22:51:43 CST 2018, time=2018-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313591, encodeId=d04b313591db, content=不错的文章值得拥有, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Wed May 09 22:43:57 CST 2018, time=2018-05-09, status=1, ipAttribution=)]
    2018-05-10 张新亮1853311252142e2fm

    好文献学习了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1447026, encodeId=899c144e026f5, content=<a href='/topic/show?id=549489135c5' target=_blank style='color:#2F92EE;'>#血检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89135, encryptionId=549489135c5, topicName=血检)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cc1f5300484, createdName=Luyuxie_11, createdTime=Fri May 11 12:58:00 CST 2018, time=2018-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313743, encodeId=fb50313e4332, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Thu May 10 08:03:59 CST 2018, time=2018-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313628, encodeId=e80e3136281c, content=学习了.有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73441710184, createdName=明崖, createdTime=Wed May 09 23:42:41 CST 2018, time=2018-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313617, encodeId=02f331361eeb, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Wed May 09 23:26:59 CST 2018, time=2018-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313595, encodeId=a354313595ef, content=出血和凝血问题与多种疾病相关.但是约90%的出凝血问题可以由血栓与止血实验室给予诊断.目前较常规的检测项目是凝血项.这些简单的检查.要是理解到位.作用不可小觑., beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Wed May 09 22:51:43 CST 2018, time=2018-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313591, encodeId=d04b313591db, content=不错的文章值得拥有, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Wed May 09 22:43:57 CST 2018, time=2018-05-09, status=1, ipAttribution=)]
    2018-05-09 明崖

    学习了.有用

    0

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    2018-05-09 changjiu

    学习一下谢谢

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1447026, encodeId=899c144e026f5, content=<a href='/topic/show?id=549489135c5' target=_blank style='color:#2F92EE;'>#血检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89135, encryptionId=549489135c5, topicName=血检)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cc1f5300484, createdName=Luyuxie_11, createdTime=Fri May 11 12:58:00 CST 2018, time=2018-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313743, encodeId=fb50313e4332, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Thu May 10 08:03:59 CST 2018, time=2018-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313628, encodeId=e80e3136281c, content=学习了.有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73441710184, createdName=明崖, createdTime=Wed May 09 23:42:41 CST 2018, time=2018-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313617, encodeId=02f331361eeb, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Wed May 09 23:26:59 CST 2018, time=2018-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313595, encodeId=a354313595ef, content=出血和凝血问题与多种疾病相关.但是约90%的出凝血问题可以由血栓与止血实验室给予诊断.目前较常规的检测项目是凝血项.这些简单的检查.要是理解到位.作用不可小觑., beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Wed May 09 22:51:43 CST 2018, time=2018-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313591, encodeId=d04b313591db, content=不错的文章值得拥有, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Wed May 09 22:43:57 CST 2018, time=2018-05-09, status=1, ipAttribution=)]
    2018-05-09 有备才能无患

    出血和凝血问题与多种疾病相关.但是约90%的出凝血问题可以由血栓与止血实验室给予诊断.目前较常规的检测项目是凝血项.这些简单的检查.要是理解到位.作用不可小觑.

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    2018-05-09 1e1b8538m79(暂无匿称)

    不错的文章值得拥有

    0