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Mixed Fibrinolytic Phenotypes in Decompensated Cirrhosis and Acute-on-Chronic Liver Failure with Hypofibrinolysis in Those With Complications and Poor Survival.
失代偿期肝硬化和慢加急性肝衰竭伴纤溶减退的并发症和生存率差的混合纤溶表型。

摘要

BACKGROUND AND AIMS:Patients with liver disease acquire complex changes in their hemostatic system, which results in a fragile rebalanced status. The status of the fibrinolytic system is controversial, as is the role of fibrinolytic dysfunction in bleeding and thrombosis in patients with cirrhosis. Here, we aimed to determine fibrinolytic status and its relationship with outcome in acutely ill patients with cirrhosis.
APPROACH AND RESULTS:We assessed plasma fibrinolytic potential in a large cohort of patients with acutely decompensated cirrhosis (AD, n = 52) or acute-on-chronic liver failure (ACLF, n = 57). Compared with 40 healthy volunteers, median clot lysis times (CLTs) were shorter in patients with AD but comparable to controls in patients with ACLF. However, the variability in CLTs in patients was much larger than in healthy controls, and in both patient groups, a proportion of patients had clearly prolonged or shortened CLTs. The variability in CLTs in patients was not readily explained by variations in plasma levels of key fibrinolytic proteins. However, CLTs were clearly related to clinical characteristics, with longer CLTs in patients with sepsis and patients with any organ failure (as defined by the European Foundation for the Study of Chronic Liver Disease organ failure scores). CLTs were not different between patients that did or did not experience bleeding or a thrombotic event during follow-up. Baseline CLTs were substantially longer in patients that died within 30 days of admission.
CONCLUSIONS:Our study demonstrates a mixed fibrinolytic phenotype in acutely ill patients with cirrhosis with baseline hypofibrinolysis associated with sepsis, organ failure, and short-term mortality. These associations may be explained by defective clearance of intraorgan microthrombi that have been proposed to drive organ failure.

译文

背景和目的: 肝病患者的止血系统发生复杂的变化,导致脆弱的再平衡状态。纤溶系统的状态是有争议的,纤溶功能障碍在肝硬化患者出血和血栓形成中的作用也是有争议的。在这里,我们旨在确定纤溶状态及其与急性肝硬化患者预后的关系。
方法和结果: 我们评估了急性失代偿期肝硬化 (AD,n = 52) 或慢加急性肝衰竭 (ACLF, n = 57)。与 40 名健康志愿者相比,AD 患者的平均凝块溶解时间 (CLTs) 更短,但与 ACLF 患者的对照组相当。然而,患者 CLTs 的变异性比健康对照组大得多,在两个患者组中,一部分患者的 CLTs 明显延长或缩短。患者 CLTs 的变异性不容易通过血浆关键纤溶蛋白水平的变化来解释。然而,CLTs 明显与临床特征相关, 在败血症患者和任何器官衰竭患者中使用较长的 CLTs (由欧洲慢性肝病研究基金会定义的器官衰竭评分)。CLTs 在随访期间发生或未发生出血或血栓事件的患者之间没有差异。入院后 30 天内死亡的患者的基线 CLTs 明显较长。
结论: 我们的研究证明了急性肝硬化患者的混合纤溶表型,基线纤溶不足与败血症、器官衰竭和短期死亡率相关。这些关联可能是由器官内微血栓清除的缺陷解释的,这些微血栓被提出来驱动器官衰竭。

acute-on-chronic liver failure

消化 急性肝损伤 疾病
概述  :  

慢加急性肝衰竭是一种慢性肝病基础上(不论既往是否诊断慢性肝炎/肝硬化)出现的急性肝损伤症候群,表现为4周内出现黄疸(血清胆红素≥5mg/dl)、凝血异常国际标准化比值(INR)≥1.5或PTA<40%],伴随腹水和(或)肝性脑病(HE)患者,具有28 d高病死率。肝性损伤[黄疸、凝血异常、肝性脑病和(或) 腹水]是必不可少的,而肝外损伤(肾脏、呼吸、循环衰竭)往往继发于主要器官即肝损伤,是一个较晚的事件。将肝外器官功能衰竭包括在慢加急性肝衰竭定义中,可能导致错过慢加急性肝衰竭潜在“

acute 英 /əˈkjuːt/  美 /əˈkjuːt/

释义   adj. 严重的,[医] 急性的;敏锐的;激烈的;尖声的

例句   Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. 霍乱是由摄入受霍乱弧菌这种杆菌污染的食物或水引起的一种急性肠道感染。

 

chronic 英 /ˈkrɒnɪk/  美 /ˈkrɑːnɪk/

释义   adj. 慢性的;长期的;习惯性的

例句   They learn how to diagnose and manage common illnesses like colds, or chronic problems such as diabetes and heart disease. 他们学会了如何诊断和处理类似感冒,或如糖尿病和心脏病常见的慢性疾病问题。

 

liver 英 /ˈlɪvə(r)/  美 /ˈlɪvər/

释义   n. 肝脏;生活者,居民

例句   The liver therefore has to maintain this balance on what it secretes into the blood and what it takes back from the blood. 因此,肝脏通过将脂质分泌到血液中同时也从血液中摄取脂质来保持这种平衡。

 

failure 英 /ˈfeɪljə(r)/  美 /ˈfeɪljər/

释义   n. 失败;故障;失败者;破产

例句   The failure will be the death of her. 这次失败对她来说将是致命的。


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