摘要
目的探讨应用Sonoclot分析凝血与血小板功能对围手术期肝移植受者凝血功能监测、病情评估及输血预测的意义。方法回顾性分析复旦大学附属中山医院2021年1月至2022年10月同时进行了Sonoclot分析、血栓弹力图(thrombelastogram,TEG)、常规凝血试验、肝功能、血常规等实验室检测并进行了急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health status score,APACHE Ⅱ)和终末期肝病模型(model for end-stage liver disease,MELD)评分的95例围手术期肝移植受者的临床资料,并对上述各项指标进行相关性分析。根据APACHE Ⅱ和MELD评分数值,将受者分为低危组、中危组和高危组,对比分析Sonoclot分析参数在各组中的水平。按有无输血,将纳入研究的95例受者分为输血组(31例)和未输血组(64例),用logistic回归和受试者工作特征(receiver operating characteristic,ROC)曲线对围手术期肝移植受者进行输血相关的危险因素分析。结果激活凝血时间(activated clotting time,ACT)与凝血酶原时间、凝血酶原比值、国际化标准比值、凝血反应时间(R值)、血液凝固时间(K值)、丙氨酸转氨酶(alanine aminotransferase,ALT)、天冬氨酸转氨酶和乳酸脱氢酶呈正相关(r=0.279 1,P=0.006 2;r=0.280 2,P=0.006 5;r=0.3,P=0.003 5;r=0.642 8,P<0.000 1;r=0.452 8,P<0.000 1;r=0.377 6,P=0.002;r=0.349 6,P=0.000 6;r=0.271 4,P=0.018 3),与血小板计数、最大振幅(maximum amplitude,MA)、凝血指数(coagulation index,CI)、凝固角(α角)呈负相关(r=-0.339 1,P=0.000 8;r=-0.573 3,P<0.000 1;r=-0.656 3,P<0.000 1;r=-0.632 6,P<0.000 1)。凝血速率(clot rate,CR)与MA、CI、α角、ALT呈正相关(r=0.466 8,P=0.000 6;r=0.482 7,P=0.000 4;r=0.514 8,P=0.000 1;r=0.229 2,P=0.027 1),与R值、K值呈负相关(r=-0.366 9,P=0.010 3;r=-0.356 9,P=0.011 0)。血小板功能(platelet function,PF)值与血小板计数、MA、CI、α角、碱性磷酸酶呈正相关(r=0.481 9,P<0.000 1;r=0.630 7,P<0.000 1;r=0.623 5
Objective To explore the significance of coagulation and platelet function analysis(Sonoclot)in monitoring coagulation function,severity evaluation and blood transfusion indication of perioperative liver transplant(LT)recipients.Methods A total of 95 perioperative LT recipients received Sonoclot,thromboelastography(TEG),routine coagulation panel,liver function panel,blood routine,acute physiology and chronic health evaluationⅡ(APACHEⅡ)scoring and model for end-stage liver disease(MELD)scoring between January 2021 and October 2022.The correlation analysis of the above parameters was performed.According to the scores of APACHEⅡand MELD,they were assigned into three groups of low-risk,medium-risk and high-risk.The levels of Sonoclot parameters in each group were compared.They were divided into two groups of transfusion(n=31)and non-transfusion(n=64)according to the necessity or non-necessity of transfusion..The risk factors for blood transfusion were examined by Logistic regression and receiver operating characteristic(ROC)curve.Results Pearson's correlation analysis indicated that activated clotting time(ACT)value was correlated positively with the levels of prothrombin time(PT),prothrombin time ratio(PTR),international standard ratio(INR),R/K value,alanine aminotransferase(ALT),aspartate aminotransferase(AST)and lactic dehydrogenase(LDH)(r=0.2791,P=0.0062;r=0.2802,P=0.0065;r=0.3,P=0.0035;r=0.6428,P<0.0001;r=0.4528,P<0.0001;r=0.3776,P=0.002;r=0.3496,P=0.0006;r=0.2714,P=0.0183)and yet negatively with the levels of platelet(PLT),MA,CI andα(r=-0.3391,P=0.0008;r=-0.5733,P<0.0001;r=-0.6563,P<0.0001;r=-0.6326,P<0.0001);CR value was correlated positively with the levels of maximal amplitude(MA),coagulation index(CI),αand ALT(r=0.4668,P=0.0006;r=0.4827,P=0.0004;r=0.5148,P=0.0001;r=0.2292,P=0.0271)and yet negatively with the level of R/K value(r=-0.3669,P=0.0103;r=-0.3569,P=0.0110);platelet function(PF)value was correlated positively with the levels of PLT,MA,CI,αand alkaline phosphatase(ALP)(r=0.4819,P<0.0001;r=0.
作者
李杨
何宇林
杨春晨
戎瑞明
章怿
Li Yang;He Yulin;Yang Chunchen;Rong Ruiming;Zhang Yi(Department of Blood Transfusion,Affiliated Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Blood Transfusion,Minhang Meilong District,Affiliated Zhongshan Hospital,Fudan University,Shanghai 201104,China;Shanghai Blood Center,Shanghai 200051,China)
出处
《中华器官移植杂志》
CAS
2023年第7期413-420,共8页
Chinese Journal of Organ Transplantation
基金
复旦大学附属中山医院青年基金(2021ZSQN78)。
关键词
肝移植
凝血功能检测
输血指征
Liver transplantation
Coagulation function test
Transfusion indication
