肝病凝血改变课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,肝病患者的凝血改变,肝病患者的凝血改变,1,置管11天,拔管4天后,置管11天,拔管4天后,2,慢性肝病患者血栓栓塞发生情况,1979-2006,E5,DVT,Figure P,om 1979-2006 of puImonary embolism(PE),dec,thrombosis(DVT),and venous thromboembolism(VTE)in hospitalized adult,paticnts with alcoholic liver discase and nonalcoholic liver disease(all difte,慢性肝病患者静脉血栓的流行情况低于其他疾病,The American Journal of Medicine(2011)124,64-68,慢性肝病患者血栓栓塞发生情况,3,门静脉血栓,门静脉血栓,4,门静脉血栓流行情况,3796例尸检患者,在主要引起门静脉血栓的病因中PVT的流行情况,n=254,Patient category,n(%)of n(%)within Age(yr),PVT patients risk category Median Mean(95%C),without primary hepatic cancer,Primary hepatobiliary cancer,59(23),721(694-748),hepatic carcinoma,extrahepatic biliary/gall bladder carcinoma,Secondary malignancy of the hepatobiliary region,111(4),690(667-71.2,from pancreatic carcinoma,gastric carcinoma,colorectal carcinoma,lung cancer,malignant lymphoma,mammary adenocarcinoma,other primary,Myeloproliferative disorders,654(442-86.6),Major abdominal infection/inflammation,1.9(665-773,No cause identified,708(659-757,All patients with PVT,254(100),699(683-71.4,门静脉血栓流行情况,5,肝硬化和肝癌患者发生门静脉血栓的风险较高,存在门静脉风险疾病的发生PVT的流行和发生的相对风险(ods比值)N=23796,Pacient category,n(%)PT(%)O.R.(95%C.),O.R.(95%CL),without primary hepatic ca,4645),0001,Primary hepatobiliary cancer,69829)5985),10.8(80-147,38097115(80-165)000,with cirrhosis,26(143)171(11-264)00028(.3-56)004,58(32-106)00,extrahepatic biliary gall bladder carcinoma,21(67),72(45-114)0.00,Secondary hepatic malignancy,from all tumours,3446(145)13033)49(38-62,from pancreatic carcinoma,36(1.5)13.9096-202),m,52(34-782003,gastric carcunoma,316,1857)59(3697,19(12-32)30.0192,colorectal carcinoma,1320),5(03-10)3,Myeloproliferative disorders,23101.0),30)30(14-63)0012,All patients,237960100)254(.0),World Gastroenter,肝硬化和肝癌患者发生门静脉血栓的风险较高,6,肝硬化患者出血发生情况,肝硬化(25%35%),门脉高压,凝血功能障碍,食管静脉曲张(90%),因素较小,肝硬化患者出血发生情况,7,正常的凝血酶生成和抑制反应,Thrombin,-TFPI,(IXa)PL(VIlla)ThrombinVIll,PS APC Thrombin-TM PC,TFV|(Xa,Thrombin-(A,X川a,rbn9nF,Fibrin x-link,正常的凝血酶生成和抑制反应,8,肝硬化患者凝血功能改变,VWF和因子水平,tPA、NO、和前列环素水平,促进和抑制凝血因子水平,纤维蛋白原和纤溶抑制剂水平,ADAMTS水平,血小板数量减少和,异常纤维蛋白原血症,功能缺陷,血小板数量功能缺陷,肝硬化患者凝血功能改变,9,肝病相关的血小板减少,肝硬化,门脉高压,脾功能亢进,血小板减少,抗血小板抗体,肝细胞癌化疗,血小板生成素水平/活性,病毒抑制/抗病毒治疗,ournal of Hepatology 48(2008)1000-1007,肝病相关的血小板减少,10,肝病凝血改变课件,11,肝病凝血改变课件,12,肝病凝血改变课件,13,肝病凝血改变课件,14,肝病凝血改变课件,15,肝病凝血改变课件,16,肝病凝血改变课件,17,肝病凝血改变课件,18,肝病凝血改变课件,19,肝病凝血改变课件,20,肝病凝血改变课件,21,肝病凝血改变课件,22,肝病凝血改变课件,23,肝病凝血改变课件,24,肝病凝血改变课件,25,肝病凝血改变课件,26,肝病凝血改变课件,27,肝病凝血改变课件,28,肝病凝血改变课件,29,