Особливості змін показників системи гемостазу та рівня с-реактивного протеїну у хворих на гострий холецистит

Abstract

Introduction. Acute cholecystitis, which is requently complicated by the bile ducts mechanical obstruction, is characterized by a variety of symptoms – from local inflammation to significant changes in hepatocytes and cholestatic intoxication. These symptoms often manifest violation of the liver functions, which is involved in the synthesis of most proteins, as the system of hemostasis, as well as the so-called «acute phase proteins».The aim of the study – to determine and conduct comparative analysis of hemostatic parameters and level of C-reactive protein (CRP) in patients with acute calculous cholecystitis (ACC).Methods of the research. 67 people were examined: 20 of them – healthy, 25 – patients with ACC without complications (1 group) and 22 – patients with ACC complicated with obstructive jaundice (2 group ). The study of hemostasis was performed by determining platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen concentration, the content of soluble fibrin-monomeric complexes (SFMC), antithrombin III activity (ATIII) and Hagemann-dependent fibrinolysis. Determination of CRP level in blood serum was also performed.Results and Discussion. We found a significant elongation of the PT, APTT, increased concentration of fibrinogen, SFMC content, Hagemann-dependent fibrinolysis and the level of CRP in patients with ACC in comparison with the control group (p<0.05, p<0.001). In addition, a significant decrease in ATIII level and reduction of the number of platelets in patients with ACC in comparison with the practically healthy people (p<0.05) was found.Conclusions. The basis of the identified changes in parameters of hemostasis system most likely lies in hepatocellular insufficiency as the cause of the reduced synthesis of many components of haemostasis on the background of inflammatory liver damage. Disorders of primary and secondary hemostasis with insufficient anticoagulants activity can lead to multiple lesions in hemodynamics and microcirculation. The increase in the content of SFMC in plasma suggests the presence of DIC syndrome. A prolongation of PT and APTT will characterize DIC syndrome as the use factors of a phase hypocoagulation.A significant increase in the level of CRP in patients with ACC complicated with obstructive jaundice indicates its involvement in the progress of the inflammatory process.