title: [Changing characteristic of blood coagulation factors and their correlation with blood coagulation status in different hepatic diseases].
abstract: OBJECTIVE
  To investigate the correlation between pro coagulation factors and anti-coagulation factors synthesized by the liver, and the correlation between fibrin degradation products (FDP) and D-dimer (D-D) concentration and coagulation proteins synthesized by extra-hepatic tissues, in different liver diseases; to explore the relationship between coagulation and bleeding in hepatic diseases.
  
  
  METHODS
  Chronic hepatitis B (CHB) patients, CHB-related liver cirrhosis patients, CHB-related liver failure patients and healthy (normal) controls were selected for study and provided blood samples for analysis. The activity of coagulation factors (F) II, V, VII, VIII, IX, X, XI, and XII was detected using the one-stage clotting method. Coagulogram analysis, including activated partial thromboplastin time (APTT), thrombin time (TT), and prothrombin time (PT), was conducted by the solidification method. Antithrombin III (AT-III) and protein C (PC) activities were measured by chromogenic substrate assay. FDP concentration was detected using immunoturbidimetry. Tissue factor pathway inhibitor (TFPI), thrombomodulin (TM), von Willebrand factor (vWF), and tissue factor (TF) concentrations were measured by enzyme-linked immunosorbent assay (ELISA).
  
  
  RESULTS
  With the exception of FVIII, coagulation factors and anticoagulant proteins synthesized by the liver were decreased and the coagulogram was extended for all patients. Likewise, the FDP and D-D concentrations were increased in blood. CHB patients, however, presented with increased levels of FVIII, TFPI, TM, vWF, and TF. Pairwise comparison indicated statistical differences existed among CHB, CHB-related liver cirrhosis, and liver failure patients: TFPI: 239.3+/-206.4, 315.0+/-258.6, and 319.5+/-298.1 -- higher than normal control: 104.0+/-87.1, F = 5.453, P less than 0.05; vWF: 70.3+/-29.5, 105.5+/-58.0, and 179.3+/-61.7 -- higher than normal control: 21.9+/-7.2, F = 20.104, P less than 0.05; TF: 85.9+/-85.7, 234.2+/-202.9, and 344.7+/-214.6 -- higher than normal control: 12.8+/-8.1, F = 8.619, P less than 0.05; FVIII: 157.2+/-53.4, 206.9+/-86.9, and 335.7+/-117.7 -- higher than normal control: 105.5+/-46.2, F = 13.418, P less than 0.05.
  
  
  CONCLUSIONS
  In parallel to the progression of liver diseases, pro coagulation and anti-coagulation elements synthesized by the liver were reduced. In contrast, fibrinolysis activity was enhanced, which is expected to lead to an imbalance between blood clotting and anti-clotting factors. This may be an important cause for the bleeding that occurs in end-stage liver disease. Expressions of TFPI, TM, vWF, and TF significantly change in the early stage of liver diseases, as compared to normal (healthy) levels, and may represent a sensitive indicator of vascular injury.
authors.affiliation: Clinical Laboratory, the PLA General Hospital, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.forename: Zhong-ping
authors.initials: ZP
authors.lastname: Duan
authors.forename: Li
authors.initials: L
authors.lastname: Bai
authors.forename: Jun
authors.initials: J
authors.lastname: Zhao
authors.forename: Mei
authors.initials: M
authors.lastname: Ding
authors.forename: Xin-yuan
authors.initials: XY
authors.lastname: Tong
authors.forename: Yu-long
authors.initials: YL
authors.lastname: Cong
mesh_terms: D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000378:metabolism; D001779:Blood Coagulation Factors / Q000378:metabolism*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D048550:Hepatic Insufficiency / Q000097:blood / Q000503:physiopathology*; D019694:Hepatitis B, Chronic / Q000097:blood / Q000503:physiopathology*; D006801:Humans; D006843:Hydrocarbons, Chlorinated / Q000378:metabolism; D008074:Lipoproteins / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D055815:Young Adult; D014841:von Willebrand Factor / Q000378:metabolism
chemical_list: D001779:Blood Coagulation Factors; D005338:Fibrin Fibrinogen Degradation Products; D006843:Hydrocarbons, Chlorinated; D008074:Lipoproteins; C036309:fibrin fragment D; C051928:lipoprotein-associated coagulation inhibitor; D014841:von Willebrand Factor; C007792:Fumigant 93; D000990:Antithrombin III