Hepatology:慢加急性肝功能衰竭(ACLF)和失代偿性肝硬化(INR)患者凝血功能衰竭

2018-06-04 MedSci MedSci原创

慢加急性肝衰竭患者经常表现出低凝血特征,纤维蛋白形成时间延长、血栓形成时间延长和凝块硬度降低。这些变化在入院后恶化,与全身炎症相关,患者短期死亡率较高。

研究背景:在慢加急性肝衰竭患者中,血浆可能出现低凝和高凝的平衡状态。慢加急性肝衰竭凝血谱的特点及预后影响尚不清楚。

研究方法:本研究纳入慢加急性肝功能衰竭(n=36)和急性失代偿(n=24)患者。在入院时和入院72小时后,测量患者血浆血栓形成(ROTEM(R))。在慢加急性肝衰竭、非慢加急性肝衰竭、存在全身炎症反应综合征、不存在全身炎症反应综合征的患者中,检测凝血特征。评估凝血状况对输血需求、出血事件和短期生存率的影响。

研究结果:入院时,相比急性失代偿患者,慢加急性肝衰竭患者的血浆样本处于低凝状态,初始纤维蛋白形成时间延长,血栓形成时间延长,最大凝块硬度和α角值降低。慢加急性肝衰竭患者72小时后血栓弹性体参数恶化,而急性失代偿患者的参数则有所改善。在入院和随访过程中,血浆处于低凝状态(≥3个血栓弹性测量参数范围)的慢加急性肝衰竭患者的比率显著增高(61% vs. 29%, p=0.03)。低凝状态与全身炎症相关,与28-d死亡率(45%比16%;p=0.02)和90-d死亡率(52%比19%;p=0.01)较高的死亡率相关,但与输血或出血不相关。基线MELD评分、纤维蛋白形成时间延长是28天死亡率的独立预测因素。

研究结论:慢加急性肝衰竭患者经常表现出低凝血特征,纤维蛋白形成时间延长、血栓形成时间延长和凝块硬度降低。这些变化在入院后恶化,与全身炎症相关,患者短期死亡率较高。

原始出处:

Blasi A, Calvo A, Prado V, et al. Coagulation failure in patients with Acute-on-Chronic Liver Failure (ACLF) and decompensated cirrhosis: beyond INR.Hepatology, 2018, May 23. doi: 10.1002/hep.30103.

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    2019-03-21 zhaozuguo
  4. 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  5. 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createdAvatar=null, createdBy=ecdc9510146, createdName=lizhou0207, createdTime=Wed Jun 06 13:57:00 CST 2018, time=2018-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321518, encodeId=2cd332151818, content=学习了很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Tue Jun 05 00:12:48 CST 2018, time=2018-06-05, status=1, ipAttribution=)]
    2018-07-19 hyf028
  6. 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  7. 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  8. 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    2018-06-06 gwc384
  9. 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    2018-06-05 飛歌

    学习了很有用

    0

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Hepatology:急性肝衰竭病人何时需要紧急肝移植?

背景:慢加急性肝衰竭(ACLF)的特点是急性失代偿期(AD)肝硬化、器官衰竭(S)和28天内的高死亡率。目的:调查研究对患者在特定时间点的评估,是否可以作为预测他们需要肝移植(LT)或潜在的治疗无效的指标。方法:从2011年的二月到九月之间,研究者评估了388例登记在册的ACLF患者;其中包括一些在欧洲慢性肝衰竭(CLIF)协会负责的前瞻性多中心肝衰竭研究中,在早期ACLF(28天)被跟踪随访的A

Gut:慢性肝衰竭急性发作患者细菌和真菌感染的患病率、特点及预后分析!

由此可见,ACLF患者发生细菌感染非常频繁。细菌感染较为严重,并伴有强烈的全身炎症反应,临床病程较差,死亡率较高。ACLF患者很容易在短时间内发生细菌感染,并可从预防策略中获益。

Gut:乙型肝炎相关慢加急性肝衰竭新的诊断标准和预后评分系统

无论肝硬化是否存在,TB≥12 mg/ dL和INR≥1.5的慢性乙型肝炎患者都应该被诊断为ACLF。近20%的HBV-ACLF患者被诊断出,从而增加了他们获得及时治疗管理的机会。

Liver Int:肝硬化门脉高压患者中循环的CXCL10可能能够反映全身炎症,并能够预测ACLF和死亡率

循环的CXCL10可能反映全身炎症,与急性失代偿、ACLF和严重门静脉高压症患者的并发症相关。CXCL10预测这些患者的生存率和CXCL10的减少可能被认为是一个好的预后因素。

Hepatology:间充质基质细胞可提高乙肝患者生存率!

由于治疗选择比较局限,乙型肝炎病毒(HBV)导致的急性慢性肝衰竭(ACLF)的死亡率很高。但是目前在临床前瞻性研究和临床研究已经证明,选择间充质基质细胞(MSC)的治疗有利于肝损伤患者的恢复。一篇发表在Hepatology的文章对此开展研究,以验证该结论的可靠性。以下是对这项研究的简要介绍。

Liver Int:细菌性感染引起的慢性肝功能衰竭与死亡率增加有关

总之,研究表明,欧洲肝病学会-慢性肝衰竭-合作组(EASL-CLIF-Consortium)提出的ACLF是肝硬化急性失代偿患者死亡率的有力预测因子。然而,相比那些未感染的患者,感染引发的ACLF患者死亡率显著增加。