CAJ | 학술논문

目的：探讨应用他克莫司免疫治疗的肝移植患者术后凝血功能的变化及意义。方法回顾性分析2012年5月至2014年12月在中山大学附属第三医院行肝移植治疗的63例患者临床资料。其中男51例，女12例；平均年龄（45±15）岁。所有患者均签署知情同意书，符合医学伦理学规定。采用他克莫司+吗替麦考酚酯+肾上腺皮质激素三联用药方案。于术前、术后当天、术后1～5 d测定患者PT、血浆纤维蛋白原（Fib）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）和Plt。检测数据的比较采用t检验。结果患者术前平均Plt为（104±37）×109/L，术后1～5 d分别为（73±21）×109/L、（60±19）×109/L、（64±20）×109/L、（50±17）×109/L、（52±17）×109/L，与术前比较，差异有统计学意义（t=-3.768，-4.462,-4.584，-2.048,-2.934；P<0.05）。其他凝血功能检测指标（PT、Fib、APTT、TT）较术前逐渐改善。结论肝移植患者术后凝血功能的恢复过程中可能会发生持续性Plt降低，应用他克莫司时应警惕血小板变化。
목적：탐토응용타극막사면역치료적간이식환자술후응혈공능적변화급의의。방법회고성분석2012년5월지2014년12월재중산대학부속제삼의원행간이식치료적63례환자림상자료。기중남51례，녀12례；평균년령（45±15）세。소유환자균첨서지정동의서，부합의학윤리학규정。채용타극막사+마체맥고분지+신상선피질격소삼련용약방안。우술전、술후당천、술후1～5 d측정환자PT、혈장섬유단백원（Fib）、활화부분응혈활매시간（APTT）、응혈매시간（TT）화Plt。검측수거적비교채용t검험。결과환자술전평균Plt위（104±37）×109/L，술후1～5 d분별위（73±21）×109/L、（60±19）×109/L、（64±20）×109/L、（50±17）×109/L、（52±17）×109/L，여술전비교，차이유통계학의의（t=-3.768，-4.462,-4.584，-2.048,-2.934；P<0.05）。기타응혈공능검측지표（PT、Fib、APTT、TT）교술전축점개선。결론간이식환자술후응혈공능적회복과정중가능회발생지속성Plt강저，응용타극막사시응경척혈소판변화。
ObjectiveTo investigate the changes of coagulation function in patients receiving tacrolimus immunotherapy after liver transplantation and its significance.MethodsClinical data of 63 patients undergoing liver transplantation in the Third Afifliated Hospital of Sun Yat-sen University between May 2012 and December 2014 were retrospectively studied. Among the 63 patients, 51 were males and 12 were females with the average of (45±15) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The triple medication regimen of tacrolimus + mycophenolate mofetil + adrenocortical hormone was utilized. Prothrombin time (PT), ifbrinogen (Fib), activated partial thromboplastin time (APTT), thrombin time (TT) and platelets count (Plt) were tested before surgery, on the day of surgery and on 1-5 d after surgery. The comparisons of the data were conducted usingt test.ResultsThe average Plt before surgery was (104±37)×109/L and the average Plt on 1-5 d after surgery was respectively (73±21)×109/L, (60±19)×109/L, (64±20)×109/L, (50±17)×109/L and (52±17)×109/L, and signiifcant difference was observed (t=-3.768,-4.462,-4.584,-2.048,-2.934;P<0.05). The other coagulation function indexes (PT, Fib, APTT and TT) were gradually improved when compared with those before surgery. ConclusionDuring the recovery of coagulation function after liver transplantation, continuous Plt decrease may occur. Plt changes should be on alert when tacrolimus is used.