摘要
目的以血栓弹力图(thrombelastography,TEG)监测多发性骨髓瘤骨病(myeloma bone disease,MBD)围手术期凝血状态,探讨其与临床分型、肿瘤分期及肝素应用相关性。方法将2013年8月至2015年3月,于我院接受手术治疗的21例MBD患者设定为研究组,同期在我院接受体检的22名健康成人设定为正常对照组。所有两组病例均于术前接受TEG及传统凝血试验检测1次,MBD组于术后第1、3、5、7天再行TEG检测各1次。结果 (1)两组间术前两种检测结果差异无统计学意义(P>0.05),K值的P=0.066,Angle角的P=0.265,MA的P=0.095,CI的P=0.315,PT的P=0.462,APTT的P=0.310,Fbg的P=0.051,TT的P=0.821,PLT的P=0.071;(2)在MBD患者围手术期出凝血状态的动态改变中,TEG检测结果差异也无明显统计学意义(P>0.05),R值的P=0.361,K值的P=0.675,Angle角的P=0.487,MA的P=0.279,EPL的P=0.398,CI的P=0.775,LY30的P=0.398;(3)MBD患者使用肝素前后TEG检测差异均无统计学意义(P>0.05),R值的P=0.518,K值的P=0.831,Angle角的P=0.676,MA的P=0.304,EPL的P=0.307,CI的P=0.971,LY30的P=0.307;(4)不同MBD分型两种检测差异均无统计学意义(P>0.05),R值的P=0.342,K值的P=0.531,Angle角的P=0.574,MA的P=0.856,EPL的P=0.737,CI的P=0.505,LY30的P=0.747,PT的P=0.393,APTT的P=0.790,Fbg的P=0.966,TT的P=0.115,PLT的P=0.460;(5)不同MBD分期两种检测差异均无统计学意义(P>0.05),R值的P=0.293,K值的P=0.198,Angle角的P=0.178,MA的P=0.515,EPL的P=0.748,CI的P=0.125,LY30的P=0.748,PT的P=0.464,APTT的P=0.649,Fbg的P=0.649,TT的P=0.646,PLT的P=0.515。结论 MBD凝血状态复杂,应用TEG可以更加全面而准确地评估,MBD围手术期管理仍存在很多问题尚未解决。
Objective Using thrombelastography（ TEG） to monitor the perioperative blood coagulation state of patients with myeloma bone disease（ MBD）, and to explore the relationship between the blood coagulation state of patients with MBD and clinical classification, tumor staging and application of heparin. Methods A total of 21 MBD patients received surgical treatment in our hospital from August 2013 to March 2015 and were registered as the research group. Twenty-two healthy adults receiving health examination were registered as the control group. TEG and traditional coagulation test were examined before the operation in all cases of 2 groups, and the MBD group also received TEG test at the 1st, 3rd, 5th and 7th day after the operation respectively. Results（ 1） There were no significant differences between MBD group and the control group in TEG and traditional coagulation test results（ P〉0.05）, the P-values of each parameter were R 0.334, K 0.066, Angle 0.265, MA 0.095, CI 0.315, PT 0.462, APTT 0.310, Fbg 0.051, TT 0.821 and PLT 0.071.（ 2） In the dynamic changes of perioperative blood coagulation of MBD patients, the results of TEG were not obviously different between pre and postoperation（ P〉0.05）, the P-values of each parameter were R 0.361, K 0.675, Angle 0.487, MA 0.279, EPL 0.398, CI 0.775, LY30 0.398.（ 3） There were no statistical significant differences between the TEG test using heparin or not（ P〉0.05） in MBD patients, the P-valuesof each parameter were R 0.518, K 0.831, Angle 0.676, MA 0.304, EPL 0.307, CI 0.971, LY30 0.307.（ 4） There was no statistical significance in the results of TEG and traditional coagulation test for different MBD classification（ P〉0.05）, the P-values of each parameter were R 0.342, K 0.531, Angle 0.574, MA 0.856, EPL 0.737, CI 0.505, LY30 0.747, PT 0.393, APTT 0.790, Fbg 0.966, TT 0.115, PLT 0.460.（ 5） There was also no statistical significance between the results of TEG of traditional coagulation test for different MBD staging（ P〉0.
作者
宇尧
杜心如
陈文明
骆辉
徐子彧
YU Yao DU Xin-ru CHEN Wen-ming LUO Hui XU Zi-yu(Department of Orthopedics, Chaoyang Hospital Capital University of Medical Sciences, Beijing, 100020, PRC)
出处
《中国骨与关节杂志》
CAS
2016年第9期700-705,共6页
Chinese Journal of Bone and Joint
