维生素K经常用在肝硬化病人中来纠正凝血机制障碍，但这种用法是缺乏证据的。我们的研究目的是为了评估VK的应用能否增加VII因子、蛋白C及蛋白S（VK依赖的凝血因子）的水平。89位病人被招募分为四组：第一组：HBV非活动性携带者（n = 23）；第二组：慢乙肝和慢丙肝（n = 21）；第三组：肝硬化（n = 24）；第四组：肝细胞癌（ n = 21）和健康对照组。给所有的病人应用维生素K10mg皮下注射。我们对凝血酶原时间、活化部分凝血酶时间、凝血酶时间、纤维蛋白原，凝血因子VII，蛋白C、总的和游离的蛋白S和因VK缺乏而诱导产生的异常凝血酶原(脱-γ-羧基凝血酶原)基线水平和应用VK72小时后的水平分别进行了测定。在研究组中异常凝血酶原在基线有累进递增，纤维蛋白原、VII因子、蛋白C及蛋白S是减少的。与基线相比，维生素K给药不影响测得的参数，而TT在所有的组中没有降低，蛋白C在第二组中减少了，FVII，总的和游离蛋白S所有组中并没有增加。维生素K治疗不会引起多数凝血参数的显着改善，因此不会似乎是经常在肝病患者中。
吉林大学第一医院肝胆胰内科 祁亚宾 摘译
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The coagulopathy of liver disease: does vitamin K help?
Vitamin K is frequently administered in cirrhotic patients to correct their coagulopathy, but evidence for such practice is lacking.We aimed to assess whether vitamin K administration increases the levels of the vitamin K-dependent factor VII (FVII), protein C, and protein S in patients with different stages of liver dysfunction.Eighty-nine patients were recruitedinto four groups: group 1 [hepatitis B virus (HBV) inactive carriers, n = 23]; group 2 [chronic HBV and hepatitis C virus (HCV) hepatitis, n = 21]; group 3 (cirrhosis, n = 24); group 4 (hepatocellular carcinoma, n = 21); and a healthy control group (n = 39). A single dose of 10 mg of vitamin K1 was administered subcutaneously to all patients. Prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen, FVII, protein C, total and free protein S, and proteins induced by vitamin K absence (PIVKA)-II (des-gamma-carboxyprothrombin) were measured at baseline and 72 h after vitamin K administration.There was progressive increment in baseline PIVKA-II, and decrements in fibrinogen, FVII, protein C, and protein S across study groups (P < 0.0001).Compared to baseline, vitamin K administration did not affect the measured parameters, whereas TT showed no reduction in any of the groups. Protein C levels declined in group 2, whereas FVII, total and free protein S did not increase in any group, for all parameters. Vitamin K therapy does not cause significant improvements in the majority of coagulation parameters and hence does not seem to be routinely indicated in patients with liver disease.
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