摘要
目的建立应用血栓弹力图(TEG)及凝血指标综合评估上消化道出血患者凝血功能的输血结局预测模型。方法从输血(科)管理系统和医院信息系统(HIS)系统收集浙江省人民医院及其淳安分院消化内科2018年6月~2021年6月收治的101名符合临床诊断标准的上消化道出血患者,根据结局是否输血分为输血组(n=56)和未输血组(n=45),以及按照肝硬化与否分为肝硬化组(n=74)和非肝硬化组(n=27),同时收集40名非上消化道出血患者的阴性对照组。对比各组的TEG检测R、K、α、MA参数,凝血功能检测PT、INR、APTT、TT、Fib,血常规检测Hb、Plt、WBC、NEUT%,以及生化检测Alb、SCr、ALT、AST、GGT等指标(值);分析TEG指标与传统凝血功能指标的相关性;采用单因素和多因素分析,筛选输血相关因素建立预测模型。结果输血组与未输血组比较:TEG的K(min)为3.86±3.12 vs 2.50±1.47,α(°)为54.00±14.08 vs 61.05±10.88,MA(mm)为51.12±13.37 vs 58.26±11.08(P<0.01);凝血指标检测PT(s)为16.36±7.45 vs 13.44±1.50,Fib(g)为1.59±0.87 vs 2.35±1.09(P<0.01);血常规检测NEUT%为0.75±0.13 vs 0.66±0.15,Hb(g/L)为68.04±14.49 vs 100.73±22.92(P<0.01);生化检测Alb(g/L)为29.73±6.08 vs 33.73±7.19,SCr(nmol/L)为99.50±53.55 vs 76.25±19.28(P<0.01)。相关性分析:APTT与R、K值呈正相关,与α、MA值呈负相关;Fib与K值呈负相关,与α、MA值呈正相关;Plt与K值呈负相关,与α、MA值呈正相关(P<0.01)。单因素分析:将得到8个输血前因素K、MA、PT、Fib、NEUT%、Hb、Alb、SCr做Logistic回归,建立输血预测模型,ROC曲线最佳输血阈值(患者输血预测值)为0.448,灵敏度92.9%,特异度88.9%,AUC0.969。结论综合上消化道出血患者TEG、凝血功能、血常规和生化等检测指标,建立Logistic回归模型对预测患者输血结局有明显的关联性,有较好的临床实用性。
Objective To establish a blood transfusion outcome prediction model for comprehensivel evaluation of coagulation function of patients with upper gastrointestinal bleeding by thrombelastogram(TEG) and blood coagulation indicators. Methods The data of 101 patients with upper gastrointestinal hemorrhage, admitted to the Department of Gastroenterology of Zhejiang Provincial People′s Hospital and its Chun′an Branch from June 2018 to June 2021,were collected through Tongshuo blood transfusion management system and His system. Those patients were divided into blood transfusion group(n=56) and non-transfusion group(n=45), and into cirrhosis group(n=74) and non-cirrhosis group(n=27), and 40 patients, with non-upper gastrointestinal bleeding, were enrolled as the control. The results of TEG indicators(R, K, α, MA), coagulation function(PT, INR, APTT, TT, Fib), blood routine(Hb, Plt, WBC, NEUT%) and biochemical detection(Alb, SCr, ALT, AST, GGT) before transfusion were compared between groups and the correlation between TEG indicators and traditional coagulation parameters was analyzed. Single-factor and multi-factor analysis were used to screen blood transfusion-related factors to establish a predictive model. Results The comparisons of paremeters between transfusion and non-transfusion group were as follows, K(min), α(°), and MA(mm) was 3.86±3.12 vs 2.50±1.47, 54.00±14.08 vs 61.05±10.88, and 51.12±13.37 vs 58.26±11.08, respectively(P<0.01);PT(s) and Fib(g) was 16.36±7.45 vs 13.44±1.50 and 1.59±0.87 vs 2.35±1.09(P<0.01);NEUT% and Hb(g/L) was 0.75 ±0.13 vs 0.66±0.15 and 68.04±14.49 vs 100.73±22.92(P<0.01);Alb(g/L) and SCr(nmol/L) was 29.73±6.08 vs 33.73±7.19 and 99.50±53.55 vs 76.25±19.28(P<0.01). Correlation analysis showed that APTT was positively correlated with R and K values, and negatively correlated with α and MA. Fib was negatively correlated with K values, and positively correlated with α and MA. Plt was negatively correlated with K values, and positively correlated with α and MA(P<0.01)
作者
杜垚强
徐怡琳
杨叶晓青
蒋璐茜
杨慧琳
王健
郝珂
王震
吕建新
陈秉宇
DU Yao-qiang;XU Yilin;YANG Yexiaoqing;JIANG Luxi;YANG Huilin;WANG Jian;HAO Ke;WANG Zhen;LYU Jianxin;CHEN Bingyu(Department of Blood Transfusion,Zhejiang Provincial People′s Hospital,Hangzhou 310014,China;School of Life Sciences,School of Laboratory Medicine,Wenzhou Medical University;Ningbo First Hospital;Zhejiang Provincial People′s Hospital(Chun′an Branch),the First People′s Hospital of Chun′an County;School of Laboratory Medi-cine,Hangzhou Medical College)
出处
《中国输血杂志》
CAS
2021年第11期1202-1206,共5页
Chinese Journal of Blood Transfusion
基金
教育部科技发展中心基金(2017A11036)
浙江省自然科学基金(LQ21H200007)。
