CAJ | 학술논문

目的：研究抗凝血因子和促凝血因子对凝血酶原时间（PT ）、活化部分凝血活酶时间（APTT ）和凝血酶生成试验（TGA）结果的影响，探讨TGA用于评估肝硬化患者血栓形成风险的价值。方法收集93名肝硬化患者和50名健康人群的血液标本，分别进行凝血象、凝血活酶、抗凝因子和抗凝血酶的测定。TGA利用荧光读数仪测定，通过软件监测绘制样本的凝血酶生成曲线。结果 PT受凝血因子（F）Ⅱ、FⅤ、FⅦ、FⅨ和蛋白C浓度的影响，而 APTT 结果主要由 FⅡ、FⅨ和 FⅩ决定。在5 pmol/L组织因子（TF）的TGA反应体系中，凝血酶生成潜力（ETP）比值受FⅡ、抗凝血酶和蛋白C水平的影响，并且肝硬化组与对照组之间没有明显差异；而在1 pmol/L T F反应体系中ET P比值主要由FⅨ和蛋白C决定，肝硬化组与对照组的ET P比值差异有统计学意义（P＜0．05）。结论 PT和 TGA 受凝血和抗凝因子的调控，并且 TGA实验对于蛋白C浓度变化较为敏感；TGA能够在PT延长的情况下，提示肝硬化患者存在血栓形成的风险，TGA可作为临床评估肝硬化患者血液高凝状态的敏感指标。
목적：연구항응혈인자화촉응혈인자대응혈매원시간（PT ）、활화부분응혈활매시간（APTT ）화응혈매생성시험（TGA）결과적영향，탐토TGA용우평고간경화환자혈전형성풍험적개치。방법수집93명간경화환자화50명건강인군적혈액표본，분별진행응혈상、응혈활매、항응인자화항응혈매적측정。TGA이용형광독수의측정，통과연건감측회제양본적응혈매생성곡선。결과 PT수응혈인자（F）Ⅱ、FⅤ、FⅦ、FⅨ화단백C농도적영향，이 APTT 결과주요유 FⅡ、FⅨ화 FⅩ결정。재5 pmol/L조직인자（TF）적TGA반응체계중，응혈매생성잠력（ETP）비치수FⅡ、항응혈매화단백C수평적영향，병차간경화조여대조조지간몰유명현차이；이재1 pmol/L T F반응체계중ET P비치주요유FⅨ화단백C결정，간경화조여대조조적ET P비치차이유통계학의의（P＜0．05）。결론 PT화 TGA 수응혈화항응인자적조공，병차 TGA실험대우단백C농도변화교위민감；TGA능구재PT연장적정황하，제시간경화환자존재혈전형성적풍험，TGA가작위림상평고간경화환자혈액고응상태적민감지표。
Objective To study the influence of pro-and anticoagulation factors on the tests of prothrombin time (PT ) ,activated partial thromboplastin time (APTT) ,and thrombin generation assay (TGA);we also investigated whether cirrhosis patients exhibit thrombosis risk using thrombomodulin (TM ) induced TGA .Methods Venous blood samples were collected from 93 cirrhosis pa-tients and 50 normal controls ,and routine coagulation tests ,coagulation factor procoagulant activity ,anticoagulant factors and an-tithrombin measurements were executed .The TGA was performed on a calibrated automated thrombogram ,given lag time ,peak time and endogenous thrombin potential (ETP) in all cirrhosis patients and controls .Results PT was significantly affected by fac-tor (F) Ⅱ ,FⅤ ,FⅦ ,FⅨ and protein C levels ;and APTT was significantly dependent on FⅡ ,FⅨ and FⅩ levels .The ETP was dependent on FⅡ ,antithrombin and protein C with 5 pmol/L tissue factor (TF) stimulation ,and FⅨ as well as protein C with 1 pmol/L TF .However the ETP ratio with 5 pmol/L TF did not increase in cirrhosis ,whereas that with 1 pmol/L TF increased sig-nificantly in cirrhosis .Conclusion PT and TGA are affected by pro-and anticoagulation factors ;even with prolonged PT ,TGA can detect hypercoagulability in cirrhosis ;the newly TGA system is a useful method to assess hypercoagulability in cirrhosis .