摘要
目的探讨血栓弹力图(TEG)对疑似静脉血栓栓塞症(VTE)患者的诊断价值。方法本研究为病例对照研究,采用非随机抽样的方法收集2018年1月至2020年12月广州医科大学附属第一医院收治的怀疑为急性VTE的普通住院患者752例,按是否确诊VTE分为VTE组103例,非VTE组649例。比较2组静脉血细胞指标红细胞计数(RBC)、血小板计数(PLT)、血凝指标凝血酶原时间(PT)、国际标准化比值(INR)、凝血酶原活动度(PTTA:)、纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)、凝血酶原时间比值(PTR)、凝血酶时间(TT)和D-二聚体指标;比较TEG参数[反应时间R值(R-time)、血块形成时间(K)、血块生成率(Angle)、最大血栓振幅(MA)、预计最大振幅后30 min的振幅衰减率(EPL)、实际最大振幅后30 min的振幅衰减率(LY30)、血块强度(G)、凝血系数(CI)、振幅30 min后的振幅(A)]。采用logistic回归分析找诊断VTE的影响因素;运用受试者工作特征曲线评价血栓弹力图各参数和D-二聚体对患者VTE的诊断价值,并将TEG参数R-time、K、Angle、MA、ELP、LY30、G、CI和A与血凝指标PT、INR、PTTA、FIB做相关分析。结果VTE组PLT、PT、FIB、APTT均高于非VTE组,D-二聚体低于非VTE组,差异有统计学意义(P值均<0.05)。VTE组Angle、MA、CI和A指标均高于非VTE组,差异有统计学意义(P值均<0.05)。logistic回归分析显示:D-二聚体、APTT、R-time和Angle是诊断VTE有价值的检测指标。VTE患者中血栓弹力图指标中Angle值、MA、G、CI、A均与FIB呈正相关(r值分别0.25、0.57、0.60、0.22、0.55,P值均<0.05)。结论TEG指标中Angle值、MA、CI和A升高的患者易发生VTE。D-二聚体、APTT、R-time和Angle是诊断VTE有价值的检测指标,当D-二聚体临界值为888μg/L和MA临界值达到67.55 mm时对VTE的诊断和预测具有更好的价值。二者联合检测可以提高特异度和准确度。
Objective To explore the diagnostic value of thromboelastography(TEG)on patients with suspected venous thromboembolism(VTE).Methods This is a case-control study,a non-random sampling method was adopted to collect 752 ordinary inpatients with suspected acute VTE,who admitted to the First Affiliated Hospital of Guangzhou Medical University from January 2018 to December 2020.Patients were divided into VTE group(n=103)and non-VTE group(n=649)after being diagnosed with VTE.The aim was to compare venous blood cell indicators such as red blood cell count(RBC),platelet count(PLT),blood coagulation indexes prothrombin time(PT),international normalized ratio(INR),prothrombin time activity(PTTA),fibrinogen(FIB),activated partial thromboplatin time(APTT),prothrombin time ratio(PTR),thrombin time(TT)and D-dimer;TEG parameters(reaction time R value[R-time],blood clot formation time[K],blood clot formation rate[Angle],maximum thrombus amplitude[MA],estimated percentage of lysis[EPL]lysis at 30 minutes[LY30],clot intensity[G],composite coagulation index[CI],and amplitude after 30 min of maximum amplitude[A])were compared between the two groups.Logistic regression analysis was applied to find the factors of VTE diagnosis.Receiver operating characteristic curve(ROC curve)was used to evaluate the diagnostic value of TEG parameters and D-dimer index in patients with VTE.A correlation analysis were performed between R-time,K,Angle,MA,ELP,LY30,G,CI,A of TEG parameters and blood coagulation indexes PT,INR,PTTA,FIB.Results PLT,PT,FIB,and APTT in VTE group were higher than those in non-VTE group,D-dimer was lower than that in non-VTE group,and the differences were statistically significant(all P<0.05);Angle,MA,CI and A in VTE group were higher than those in non-VTE group,and with statistically significant difference(all P<0.05).Logistic regression analysis showed that D-dimer,APTT,R-time and Angle were valuable detection indexes for diagnosis of VTE.In VTE patients,Angle values,MA,G,CI,A of TEG indexes were positively correlated with FIB
作者
何嘉豪
江倩
张挪富
刘春丽
He Jiahao;Jiang Qian;Zhang Nuofu;Liu Chunli(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)
出处
《国际呼吸杂志》
2022年第3期168-174,共7页
International Journal of Respiration
基金
科技部国家重点研发计划(2016YFC1304102)
广州医科大学高水平临床研究提升计划(B185004065)
呼吸疾病国家重点实验室自主课题(SKDRD-MS-201901)。
