血栓弹力图评估儿童系统性红斑狼疮出凝血状态  

Study on coagulation status in children w ith system ic lupus erythem atosus by throm belastography

作　　者：李卓[1] 肖娟[1] 宋红梅[1] 陈倩[2] 李冀[1] 张乐嘉[1] 何艳燕[1] 魏珉[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院儿科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院检验科,北京100730

出　　处：《中国循证儿科杂志》2014年第2期127-131,共5页Chinese Journal of Evidence Based Pediatrics

基　　金："十一五"科技支撑项目资助:2008BAI59B02

摘　　要：目的应用血栓弹力图(TEG)检测系统性红斑狼疮(SLE)患儿的总体出凝血紊乱状态,探讨SLE患儿不同疾病状态与出凝血的关系,监测SLE患儿临床出血或血栓事件。方法选取2012年1月至2013年6月于北京协和医院住院的连续SLE患儿为SLE组,无血液系统疾病及自身免疫性疾病的健康成人为正常对照组。根据SLEDAI评分对SLE患儿进行病情状态分组。分析SLE组与正常对照组,以及不同疾病活动状态下SLE患儿TEG结果的差异。结果 SLE组纳入39例,年龄(11.3±2.6)岁,平均病程12.1个月;行58例次TEG检查,其中重度活动15例次,中度活动15例次,轻度活动11例次,基本无活动17例次。正常对照组10名,年龄(27.7±3.7)岁。①SLE组1例发生出血,3例发生血栓事件,其TEG图形显著不同。②与正常对照组相比,SLE组TEG中反应时间(R)、血凝块形成时间(K)缩短,30 min内血凝块消融的百分比(LY30)减小,凝血指数(CI)增大(P均<0.05),凝血功能整体呈高凝状态。③重度活动与基本无活动和轻度活动病情状态相比,R明显缩短,α角和CI增大(P均<0.01);与中度活动病情状态相比,R缩短,CI增大(P均<0.05)。④SLEDAI评分与R、K及LY30均呈负相关(r分别为-0.429、-0.402和-0.316,P分别为0.001、0.002和0.016),与α角、CI均呈正相关(r分别为0.458和0.445,P均为0.000),与最大振幅无相关性(r=0.152,P=0.256)。结论 SLE患儿出凝血功能可呈紊乱状态,既可表现为高凝和血栓,亦可表现为出血,通过TEG可清晰地检测。SLE患儿凝血功能总体呈高凝状态。SLE患儿活动度高者高凝状态更明显。TEG评估SLE出凝血紊乱状态方便易行。Objective To explore an assay- that can evaluate the coagulation disorders in children with SLE, to investigate the correlation of disease activity of SLE and coagulation disorders and to monitor the events of bleeding or thrombosis and guiding clinical management. SLE pediatric patients and healthy controls were recruited. The illness status of SLE patients was divided by SLEDAI scores. TEG parameters of patients and healthy controls were analyzed. Results A total of 39 SLE patients performed 58 TEG examinations. The mean age of patients was 11.3 ± 2.6 （5 - 17 ） years. TEG was performed as follows： 15 examinations in severe activity status, 15 examinations in moderate activity status, 11 examinations in mild activity status and 17 examinations in no activity- status. The mean age of healthy control group was 27.7 ± 3.7 （ 24 - 33 ） years. ①Among the SLE pediatric patients, bleeding and thrombosis were seen in 1 and 3 patients, respectively. Their TEG curves were different significantly. ②Compared with the control group, the TEG variables of SLE pediatric patients showed hypercoagulability, whose R and K times were shortened, LY30 was decreased and CI was increased （P 〈 0.05）. ③Hypercoagulability of SLE pediatric patients with higher SLEDAI scores was more obvious, whose R-time was shortened, a-angle and CI were increased （ P 〈 0. 01 ）. Furthermore, there was negative correlation between K-time and SLEDAI （r = - 0.429, P 〈 0.01 ） as well as R-time and SLEDAI （ r = - 0. 402, P 〈 0.01 ） ; also, there was positive correlation between α-angle and SLEDAI （ r = 0.458, P 〈 0.01 ） as well as CI and SLEDAI （r = 0.445, P 〈 0.01 ） .Conclusion SLE pediatric patients with coagulation disorders showed hypereoagulability or hypoeoagulability. TEG could distinguish them clearly. SLE pediatric patients showed hypereoagulability and was associated with disease activity. TEG could be a potential tool to evaluate the coagulation status of SLE.

关 键 词：系统性红斑狼疮 血栓弹力图 凝血状态 儿童 

分 类 号：R725.5[医药卫生—儿科]