Abstract
In order to clarify diagnostic significance of blood coagulation tests in various hepatobiliary diseases, the activities of coagulation factors measured by Hepaplastintest, Thrombotest and prothrombin time, and the inhibition index (P IVKA) as well as the lipid contents in blood, which may influence on coagulation system, were analysed.
Results: An average value of Hepaplastintest in patients with acute hepatitis was 90±31%. In the course of acute hepatitis, the value of Hepaplastintest dropped under 60% at the stage of climax, and recovered rapidly to the normal range in two or three weeks preceding the normalization of other liver function tests. While the activities of coagulation factors were fluctuated markedly in the course of acute hepatitis, they used to fix in a lower range with lesser fluctuation when it is developed to chronic hepatitis.
In chronic liver diseases, an average value of Hepaplastintest was 79±18% in chronic hepatitis and 56±16% in cirrhosis of the liver.
Hypercoagulable state was observed in the hepatobiliary diseases with hyperlipemia such as obstructive jaundice, intrahepatic cholestasis and primary biliary cirrhosis. Hypercoagulation state was also seen in hyperlipemic patients without liver damage and in nephrotic syndrome without azotemia. These findings suggest that serum lipids may accelerate the activity of coagulation systems.
The presence of endogenous inhibition on coagulation systems, expressed by Inhibition Index (value of Hepaplastintest-value of Thrombotest/value of Hepaplastintest), was observed at the climax of acute hepatitis, in the course of chronic active hepatitis and in obstructive jaundice. In the course of acute hepatitis, Inhibition Index rose at the stage of climax and dropped to the normal range in accordance with the normalization of the values of coagulation tests. While hypocoagulation state, seen in the severe obstructive jaundice, was normalized by the administration of vitamin K with normalization of coagulation activity and Inhibition Index.
Conclusion: In the various liver function test, Hepaplastintest is the most sensitive and suitable to evaluate an ability of protein synthesis of the hepatocytes in various hepatobiliary diseases, and if the clinical course of the diseases is followed by Hepaplastintest and Thrombotest as well as Inhibition Index, the significant informations may be derived for the understanding of the pathophysiological phases and the evaluation of their prognosis.
