摘要
目的探讨血栓弹力图(thrombelastography,TEG)监测指导高危静脉血栓栓塞症(Venous thromboembolism,VTE)肿瘤病人早期临床治疗的效果及预后观察。方法选取2016年1月至2019年1月期间上海市静安区市北医院收治的168例高危VTE住院肿瘤病人临床资料进行回顾性分析,根据治疗方法不同分为观察组和对照组。观察组82例采用间歇性气囊加压装置治疗,并在TEG监测下进行抗凝+抗血小板治疗。对照组86例仅采用间歇性气囊加压装置治疗。随访终点为有症状VTE发生及出血出现,比较达到研究终点后两组VTE发生率及出血发生率,分析TEG监测指标对高危VTE肿瘤病人治疗预后的预测价值。结果观察组VTE发生率(4.88%)低于对照组(24.42%)(χ……2=12.654,P=0.000);观察组出血发生率(1.16%)与对照组(3.66%)差异无统计学意义(χ……2=0.307,P=0.579);VTE组、出血组及无VTE/出血组凝血时间(R)、最大振幅(MA)及综合凝血指数(CI)值比较,差异有统计学意义(P<0.05);低R值(OR=0.884,95%CI:0.811~0.964)、高CI值(OR=1.119,95%CI:1.012~1.236)是影响接受治疗高危VTE肿瘤病人VTE发生的独立危险因素;经ROC曲线分析,R值和CI值预测高危VTE肿瘤病人VTE发生的曲线下面积分别为0.788和0.813,均具有较高预测价值。结论TEG监测指标R值和CI值能有效预测高危VTE肿瘤病人VTE发生风险,根据TEG监测指导高危VTE肿瘤病人早期临床治疗,能有效降低VTE发生风险,且不会明显增加出血风险。
Objective To explore the therapeutic effects and prognosis of thrombelastography(TEG)monitoring in guiding early clinical treatment of patients with high-risk venous thromboembolism(VTE).Methods The clinical data of 168 cancer patients with high-risk VTE hospitalized in Shibei Hospital,Jing’an District,Shanghai from January 2016 to January 2019 were retrospectively analyzed.They were assigned into observation group and control group according to different treatment methods.82 patients in observation group were treated with intermittent balloon compression device and given anticoagulation+antiplatelet therapy under TEG monitoring,while 86 patients in control group were treated with intermittent balloon compression device only.The follow-up endpoint was taken as occurrence of symptomatic VTE and hemorrhage,and the incidence rate of VTE and incidence rate of hemorrhage were compared between the two groups after reaching the endpoint.The predictive value of TEG monitoring indexes on treatment prognosis of patients with high-risk VTE tumors was analyzed.Results The incidence rate of VTE in observation group(4.88%)was lower than that in control group(24.42%)(χ^2=12.654,P=0.000).The incidence rate of hemorrhage in observation group(1.16%)was higher than that in control group(3.66%)(χ^2=0.307,P=0.579).There were significant differences in the clotting time(R),maximum amplitude(MA)and coagulation(CI)among VTE group,hemorrhage group and non-VTE/hemorrhage group(P<0.05).The low R value(OR=0.884,95%CI:0.811-0.964)and high CI value(OR=1.119,95%CI:1.012-1.236)were independent risk factors affecting the VTE in patients with high-risk VTE tumors.ROC curve analysis showed that the values of area under the curve of R and CI values in predicting VTE in patients with high-risk VTE tumors were 0.788 and 0.813,respectively,and both had higher predictive value.Conclusions The TEG monitoring indexes of R value and CI value can effectively predict the risk of VTE in patients with high-risk VTE tumors.According to TEG monitoring guida
作者
王玮
张为强
叶维洁
王玉树
WANG Wei;ZHANG Weiqiang;YE Weijie;WANG Yushu(Department of Oncology,Shibei Hospital,Jing’an District,Shanghai 200435,China)
出处
《安徽医药》
CAS
2020年第6期1151-1154,I0004,共5页
Anhui Medical and Pharmaceutical Journal
基金
2018年上海市静安区市北医院医学科研课题(2018SBMS07)。
关键词
静脉血栓栓塞
间歇性气体压缩装置
肝素
低分子量
阿司匹林
血栓弹力图
肿瘤病人
预后
受试者工作特征曲线
Venous thromboembolism
Intermittent pneumatic compression devices
Heparin,low-molecular-weight
Aspirin
Thromboelastography
Tumor patients
Prognosis
Receiver operating characteristic(ROC)
